Provider Demographics
NPI:1770505729
Name:BASISHT, GOPAL K (MD)
Entity Type:Individual
Prefix:DR
First Name:GOPAL
Middle Name:K
Last Name:BASISHT
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 1:1300 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6351
Mailing Address - Country:US
Mailing Address - Phone:407-423-5520
Mailing Address - Fax:
Practice Address - Street 1:1300 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6351
Practice Address - Country:US
Practice Address - Phone:407-423-5520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0027658207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056970400Medicaid
FL056970400Medicaid
FL48876Medicare ID - Type Unspecified