Healthcare Provider Details

I. General information

NPI: 1972815983
Provider Name (Legal Business Name): VIKRAM PRAKASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 W GORE ST FL 2
ORLANDO FL
32806-1114
US

IV. Provider business mailing address

100 W GORE ST STE 600
ORLANDO FL
32806-1051
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-3050
  • Fax: 321-843-3570
Mailing address:
  • Phone: 321-841-3050
  • Fax: 321-843-3570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2014039430
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberEMC0007196
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number337800
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD488820C
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberME135044
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: