Healthcare Provider Details

I. General information

NPI: 1821655655
Provider Name (Legal Business Name): VARUN GOVIND RAMAKRISHNAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DRIVE, MCC-GME
TAMPA FL
33612
US

IV. Provider business mailing address

12902 USF MAGNOLIA DRIVE, MCC-GME
TAMPA FL
33612
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-8535
  • Fax:
Mailing address:
  • Phone: 813-745-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberTRN44871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: