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General NPI Number Information
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NPI Number | 1760961312
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Entity Type | Individual
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Provider Name | BHARATHRAM VASUDEVAN MBBS
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Gender | Male
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1600 SW ARCHER RD
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City | GAINESVILLE
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State | FL
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Zip | 32610-3003
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Country | US
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Telephone | 352-273-8610
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Fax |
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Provider Business Mailing Address
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Address Line | 1969 W OGDEN AVE
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City | CHICAGO
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State | IL
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Zip | 60612-3765
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME164957
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 125074909
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | ME164957
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | R-11367
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License Number State | IA
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