Provider Demographics
NPI:1073577672
Name:BIKKASANI, NAVEEN (MD)
Entity Type:Individual
Prefix:MR
First Name:NAVEEN
Middle Name:
Last Name:BIKKASANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13470 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6820
Mailing Address - Country:US
Mailing Address - Phone:352-597-0016
Mailing Address - Fax:352-597-0089
Practice Address - Street 1:13470 TAFT ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613
Practice Address - Country:US
Practice Address - Phone:352-597-0016
Practice Address - Fax:352-597-0089
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME925552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272265800Medicaid
FL01526Medicare ID - Type Unspecified
FL272265800Medicaid