MEDICARE: BHARATH GOPAL RATHAKRISHNAN M.D.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RI0011X	Interventional Cardiology Physician	ME163408	FL
3	207RI0011X	Interventional Cardiology Physician	280655	MA
4	207RC0000X	Cardiovascular Disease Physician	280655	MA

General Provider Information

NPI Number	:	1770978066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHARATH GOPAL RATHAKRISHNAN M.D.

Provider Business Mailing Address
First Line	:	2400 N ORANGE BLOSSOM TRL STE 204
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-2307
Country	:	US
Telephone Number	:	407-932-6226
Fax Number	:	407-553-2177

Provider Business Practice Location Address
First Line	:	2400 N ORANGE BLOSSOM TRL STE 204
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-2307
Country	:	US
Telephone Number	:	407-932-6226
Fax Number	:	407-553-2177

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

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	02/09/2026

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Directions to “ BHARATH GOPAL RATHAKRISHNAN M.D.” Practice Location

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