=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972815983
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIKRAM PRAKASH M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2010
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 W GORE ST FL 2
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-841-3050
-----------------------------------------------------
Fax | 321-843-3570
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 W GORE ST STE 600
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-1051
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-841-3050
-----------------------------------------------------
Fax | 321-843-3570
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0402X
-----------------------------------------------------
Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
-----------------------------------------------------
License Number | EMC0007196
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0402X
-----------------------------------------------------
Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
-----------------------------------------------------
License Number | ME135044
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084N0402X
-----------------------------------------------------
Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
-----------------------------------------------------
License Number | 337800
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 2014039430
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------