| Radhika Prakash, Md | |
|
2758 Us S 1 South St. Augustine FL 32086 | |
| (904) 797-2338 | |
| (904) 797-2331 |
| Full Name | Radhika Prakash, Md |
|---|---|
| Speciality | Internal Medicine |
| Location | 2758 Us S 1 South, St. Augustine, Florida |
| Authorized Official Name and Position | Radhika Prakash (MD) |
| Authorized Official Contact | 9047972338 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Radhika Prakash, Md Po Box 860120 St Augustine FL 32086-0120 Ph: (904) 797-2338 | Radhika Prakash, Md 2758 Us S 1 South St. Augustine FL 32086 Ph: (904) 797-2338 |
| NPI Number | 1164810503 |
|---|---|
| Provider Enumeration Date | 01/08/2015 |
| Last Update Date | 01/08/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164810503 | NPI | - | NPPES |
| 55118 | Other | FL | BLUE CROSS BLUE SHIELD |
| 009180500 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME0041524 (Florida) | Primary |
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