Provider Demographics
NPI:1770978066
Name:RATHAKRISHNAN, BHARATH GOPAL (MD)
Entity type:Individual
Prefix:
First Name:BHARATH
Middle Name:GOPAL
Last Name:RATHAKRISHNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6200 SUNSET DR STE 401
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4829
Mailing Address - Country:US
Mailing Address - Phone:305-666-4633
Mailing Address - Fax:305-667-1675
Practice Address - Street 1:6200 SUNSET DR STE 401
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4829
Practice Address - Country:US
Practice Address - Phone:305-666-4633
Practice Address - Fax:305-667-1675
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA280655207RI0011X, 207RC0000X
390200000X
FL163408207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease