Healthcare Provider Details

I. General information

NPI: 1497068423
Provider Name (Legal Business Name): MADHU BAGARIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4761 S CLEVELAND AVE STE 4
FORT MYERS FL
33907-1375
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-6100
  • Fax: 239-343-9727
Mailing address:
  • Phone: 239-343-6100
  • Fax: 239-343-9727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number59649
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME182899
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301096090
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: