1184921645 NPI number — PINAKIN G. BHAKTA M.D.,P.C.

Table of content: (NPI 1184921645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184921645 NPI number — PINAKIN G. BHAKTA M.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINAKIN G. BHAKTA M.D.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184921645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17100 N. 67TH AVE.
Provider Second Line Business Mailing Address:
SUITE 602
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-3605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-978-5005
Provider Business Mailing Address Fax Number:
602-978-1115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17100 N 67TH AVE
Provider Second Line Business Practice Location Address:
SUITE 602
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85308-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-978-5005
Provider Business Practice Location Address Fax Number:
602-978-1115
Provider Enumeration Date:
02/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BHAKTA
Authorized Official First Name:
SHEELABEN
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
602-978-5005

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  27723 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 485434 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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