Provider Demographics
NPI:1669836847
Name:AKRO GASTRO, LLC
Entity Type:Organization
Organization Name:AKRO GASTRO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TARUGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-824-3447
Mailing Address - Street 1:201 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-6117
Mailing Address - Country:US
Mailing Address - Phone:863-824-3347
Mailing Address - Fax:863-824-3472
Practice Address - Street 1:201 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-6117
Practice Address - Country:US
Practice Address - Phone:863-824-3347
Practice Address - Fax:863-824-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME10611261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112076000Medicaid
FLPP930OtherMEDICARE PTAN
FL1669836847OtherNPI FOR AKRO GASTRO