Healthcare Provider Details

I. General information

NPI: 1780675561
Provider Name (Legal Business Name): VINOD KUMAR BHATNAGAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 METRO PKWY STE 205
FORT MYERS FL
33916-9416
US

IV. Provider business mailing address

4310 METRO PKWY STE 205
FORT MYERS FL
33916-9416
US

V. Phone/Fax

Practice location:
  • Phone: 239-223-2751
  • Fax:
Mailing address:
  • Phone: 239-223-2751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME39984
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME39984
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: