MEDICARE: DR. BERNARD BAROUDI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME153033	FL
2	208M00000X	Hospitalist Physician	ME153033	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053808618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNARD BAROUDI

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE STE 200
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9328
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:

Provider Business Practice Location Address
First Line	:	2343 AARON ST
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5305
Country	:	US
Telephone Number	:	855-979-5700
Fax Number	:	855-979-5701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2018
Last Update Date	:	03/04/2026

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Directions to “ DR. BERNARD BAROUDI ” Practice Location

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