Healthcare Provider Details

I. General information

NPI: 1144532680
Provider Name (Legal Business Name): THIAGO BEDUSCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-1005
US

IV. Provider business mailing address

1600 SW ARCHER RD BOX 100118
GAINESVILLE FL
32610-0286
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0606
  • Fax: 352-265-0678
Mailing address:
  • Phone: 352-265-0606
  • Fax: 352-265-0678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number11015250A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberME115700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: