MEDICARE: DR. BHASKAR GOPALAKRISHNAN MD

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	207L00000X	Anesthesiology Physician	34580	AZ
2	207L00000X	Anesthesiology Physician	036166771	IL

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	:	1265492169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHASKAR GOPALAKRISHNAN MD

Provider Business Mailing Address
First Line	:	11 CURLEW CT
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1651
Country	:	US
Telephone Number	:	917-566-2969
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 N WINFIELD RD
Second Line	:
City	:	WINFIELD
State	:	IL
Zip	:	60190-1379
Country	:	US
Telephone Number	:	630-933-6675
Fax Number	:	630-933-2614

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	11/09/2023

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