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General NPI Number Information
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NPI Number | 1487301917
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Entity Type | Organization
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Legal Business Name | MARLEY MEDICAL PROVIDER GROUP, P.A.
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Dates
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Enumeration Date | 03/04/2022
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 2332 GALIANO ST FL 2
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City | CORAL GABLES
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State | FL
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Zip | 33134-5402
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Country | US
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Telephone | 305-998-0713
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Fax |
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Provider Business Mailing Address
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Address Line | 2332 GALIANO ST FL 2
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City | CORAL GABLES
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State | FL
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Zip | 33134-5402
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIKRAM DEEPAK BAKHRU
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Credential | MD
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Telephone | 888-811-9064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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