Healthcare Provider Details

I. General information

NPI: 1427269018
Provider Name (Legal Business Name): VIKRAM TARUGU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SW 16TH ST
OKEECHOBEE FL
34974-6117
US

IV. Provider business mailing address

201 SW 16TH ST
OKEECHOBEE FL
34974-6117
US

V. Phone/Fax

Practice location:
  • Phone: 863-824-3447
  • Fax: 863-824-3472
Mailing address:
  • Phone: 863-824-3447
  • Fax: 863-824-3472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME106111
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: