MEDICARE: MYATLAS PROVIDER GROUP, P.A.

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1376473421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYATLAS PROVIDER GROUP, P.A.

Provider Business Mailing Address
First Line	:	2332 GALIANO ST FL 2
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-5402
Country	:	US
Telephone Number	:	305-701-4286
Fax Number	:

Provider Business Practice Location Address
First Line	:	2332 GALIANO ST FL 2
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-5402
Country	:	US
Telephone Number	:	305-701-4286
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VIKRAM BAKHRU
Credential	:	MD
Telephone Number	:	305-701-4286

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	05/20/2026

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