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Organization
RADHIKA PRAKASH, MD
Active
Organization
RADHIKA PRAKASH, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RADHIKA PRAKASH (MD)
(904) 797-2338
Entity
Organization
Contact information
Practice address
2758 US S 1 SOUTH, ST. AUGUSTINE, FL 32086
(904) 797-2338
(904) 797-2331
Mailing address
PO BOX 860120, ST AUGUSTINE, FL 32086-0120
(904) 797-2338
(904) 797-2331
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME0041524
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009180500
—
FL
01
—
55118
BLUE CROSS BLUE SHIELD
FL
Enumeration date
01/08/2015
Last updated
01/08/2015
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