Provider Demographics
NPI:1013977339
Name:BHADKAMKAR, SANDEEP VIDYADHAR (MD)
Entity Type:Individual
Prefix:
First Name:SANDEEP
Middle Name:VIDYADHAR
Last Name:BHADKAMKAR
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 1:6701 AIRPORT BLVD STE D143
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-6701
Mailing Address - Country:US
Mailing Address - Phone:251-342-3949
Mailing Address - Fax:251-266-3361
Practice Address - Street 1:6801 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3709
Practice Address - Country:US
Practice Address - Phone:251-266-3580
Practice Address - Fax:251-266-3581
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG859OtherMEDICARE GROUP NUMBER
AL25799OtherMEDICAL LICENSE
P00382845OtherRAILROAD MEDICARE
AL631706030Medicaid
AL25799OtherMEDICAL LICENSE
ALG859OtherMEDICARE GROUP NUMBER