Provider Demographics
NPI:1639110018
Name:RAMKISSOON, BRIDGLAL (MD)
Entity Type:Individual
Prefix:
First Name:BRIDGLAL
Middle Name:
Last Name:RAMKISSOON
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 1:4325 SUN N LAKE BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2171
Mailing Address - Country:US
Mailing Address - Phone:863-402-0066
Mailing Address - Fax:863-402-0030
Practice Address - Street 1:4325 SUN N LAKE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2171
Practice Address - Country:US
Practice Address - Phone:863-402-0066
Practice Address - Fax:863-402-0030
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME745902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology