Provider Demographics
NPI:1700831088
Name:GOPAL, INDULEKHA N (MD)
Entity Type:Individual
Prefix:
First Name:INDULEKHA
Middle Name:N
Last Name:GOPAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 CORAL HILLS DRIVE
Mailing Address - Street 2:STE 220
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4146
Mailing Address - Country:US
Mailing Address - Phone:954-345-0404
Mailing Address - Fax:954-346-8315
Practice Address - Street 1:2901 CORAL HILLS DRIVE
Practice Address - Street 2:STE 220
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4146
Practice Address - Country:US
Practice Address - Phone:954-345-0404
Practice Address - Fax:954-346-8315
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92182207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271818900Medicaid
FLI25892Medicare UPIN
FLU4300ZMedicare ID - Type Unspecified