Basic Information
| Provider Information | |||||||||
| NPI: | 1013977339 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHADKAMKAR | ||||||||
| FirstName: | SANDEEP | ||||||||
| MiddleName: | VIDYADHAR | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6701 AIRPORT BLVD STE D143 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366086701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2513423949 | ||||||||
| FaxNumber: | 2512663361 | ||||||||
| Practice Location | |||||||||
| Address1: | 6801 AIRPORT BLVD | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366083709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2512663580 | ||||||||
| FaxNumber: | 2512663581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 04/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 00025799 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | G859 | 01 | AL | MEDICARE GROUP NUMBER | OTHER | 25799 | 01 | AL | MEDICAL LICENSE | OTHER | P00382845 | 01 | RAILROAD MEDICARE | OTHER | 631706030 | 05 | AL | MEDICAID |