Provider Demographics
NPI:1427269018
Name:TARUGU, VIKRAM (MD)
Entity type:Individual
Prefix:
First Name:VIKRAM
Middle Name:
Last Name:TARUGU
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 1:201 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974-6117
Mailing Address - Country:US
Mailing Address - Phone:863-824-3447
Mailing Address - Fax:863-824-3472
Practice Address - Street 1:201 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974-6117
Practice Address - Country:US
Practice Address - Phone:863-824-3447
Practice Address - Fax:863-824-3472
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106111207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL146ZWOtherBCBS
FLPP929OtherMEDICARE PTAN
FL112076000Medicaid