Provider Demographics
NPI:1265494058
Name:BHARGAVA, MUKUL (MD)
Entity Type:Individual
Prefix:
First Name:MUKUL
Middle Name:
Last Name:BHARGAVA
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 1:7154 N UNIVERSITY DR # 316
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2916
Mailing Address - Country:US
Mailing Address - Phone:954-720-3188
Mailing Address - Fax:954-586-2589
Practice Address - Street 1:4485 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5876
Practice Address - Country:US
Practice Address - Phone:954-720-3188
Practice Address - Fax:954-586-2589
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58399207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256929900Medicaid
FL42455WMedicare PIN
FLE71226Medicare UPIN