Provider Demographics
NPI:1760453427
Name:PUSKUR, BHAVANI (MD)
Entity Type:Individual
Prefix:DR
First Name:BHAVANI
Middle Name:
Last Name:PUSKUR
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 1:1185 TALON WAY
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-3257
Mailing Address - Country:US
Mailing Address - Phone:321-757-1900
Mailing Address - Fax:866-376-2481
Practice Address - Street 1:2328 CITADEL WAY STE 103-319
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-6459
Practice Address - Country:US
Practice Address - Phone:321-757-1900
Practice Address - Fax:866-376-2481
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93837207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273804000Medicaid
TN103846OtherBC
39790Medicare ID - Type UnspecifiedGROUP
TN103846OtherBC