Healthcare Provider Details

I. General information

NPI: 1578664769
Provider Name (Legal Business Name): BELANJE SUDHAKARA HEGDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7776 EVENING STAR LANE
TALLAHASSEE FL
32312-3555
US

IV. Provider business mailing address

7776 EVENING STAR LANE
TALLAHASSEE FL
32312-3555
US

V. Phone/Fax

Practice location:
  • Phone: 850-893-8920
  • Fax: 850-893-0144
Mailing address:
  • Phone: 850-893-8920
  • Fax: 850-893-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number23629
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number019952
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: