Individual
PRASANNA KUMAR BASAVEGOWDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5955 PONCE DE LEON BLVD, CORAL GABLES, FL 33146-2423
(305) 662-8668
(305) 662-3723
Mailing address
5955 PONCE DE LEON BLVD, CORAL GABLES, FL 33146-2423
(305) 662-8668
(305) 662-3723
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
ME 76168
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255737100
—
FL
Enumeration date
09/15/2006
Last updated
07/08/2007
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