Individual
ADIKKAN OANTHAN RAJAGOPAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3949 EVANS AVE, SUITE 102, FORT MYERS, FL 33901-9335
(239) 939-2622
(239) 939-0151
Mailing address
3949 EVANS AVE, SUITE 102, FORT MYERS, FL 33901-9335
(239) 939-2622
(239) 939-0151
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
4301036289
MI
207L00000X
Anesthesiology Physician
Primary
ME29883
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050G310140
BCBS OF MI
MI
05
—
278064000
—
FL
01
—
5829419
AETNA
FL
01
—
96524
BCBS
FL
01
—
AD661Z
GTBA MEDICARE REASSIGN
FL
01
—
B43873
UPIN
—
Enumeration date
01/31/2006
Last updated
03/19/2009
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