Healthcare Provider Details

I. General information

NPI: 1568338473
Provider Name (Legal Business Name): KINSTEAD PROVIDER GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E PRATT ST FL 8
BALTIMORE MD
21202-3180
US

IV. Provider business mailing address

2332 GALIANO ST FL 2
CORAL GABLES FL
33134-5402
US

V. Phone/Fax

Practice location:
  • Phone: 305-998-0546
  • Fax: 305-414-0848
Mailing address:
  • Phone: 305-998-0546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. VIKRAM DEEPAK BAKHRU
Title or Position: PRESIDENT
Credential: MD
Phone: 305-998-0546