Provider Demographics
NPI:1770503526
Name:VASUDEVAN, ARVIND (MD)
Entity type:Individual
Prefix:DR
First Name:ARVIND
Middle Name:
Last Name:VASUDEVAN
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 1:11215 METRO PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966-1206
Mailing Address - Country:US
Mailing Address - Phone:239-208-2212
Mailing Address - Fax:239-208-3994
Practice Address - Street 1:11215 METRO PKWY STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1206
Practice Address - Country:US
Practice Address - Phone:239-208-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD2137962084N0400X
NC2008-018402084N0400X
TXT95232084N0400X
WV218792084N0400X
PAMD4602902084N0400X
FLME1565682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911703Medicaid
NC1770503526Medicaid
SCNC2228Medicaid
WV001845720OtherBLUE CROSS/BLUE SHIELD
WV001845720OtherBLUE CROSS/BLUE SHIELD
NC5911703Medicaid
NC1770503526Medicaid
NCNCE842C904Medicare PIN