Provider Demographics
NPI:1821109786
Name:NAROTAM, PRADEEP K (MD, FACS, PHD)
Entity Type:Individual
Prefix:DR
First Name:PRADEEP
Middle Name:K
Last Name:NAROTAM
Suffix:
Gender:M
Credentials:MD, FACS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3997 MIMOSA PL
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3675
Mailing Address - Country:US
Mailing Address - Phone:727-332-9024
Mailing Address - Fax:727-865-5285
Practice Address - Street 1:13121 66TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-1812
Practice Address - Country:US
Practice Address - Phone:727-314-8180
Practice Address - Fax:727-474-6527
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME146515204D00000X, 2086S0102X, 207T00000X, 207T00000X
IL036.139412207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL813663Medicaid
INP00459736OtherRR MEDICARE
INP00459736OtherRAILROAD MEDICARE
IN0510320012Medicare NSC
IN098533Medicare PIN
IN200890190Medicaid
IN941090A33Medicare PIN
INP00459736OtherRR MEDICARE