1194740738 NPI number — INDIRA BHAGAT MD

Table of content: INDIRA BHAGAT MD (NPI 1194740738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194740738 NPI number — INDIRA BHAGAT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHAGAT
Provider First Name:
INDIRA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1194740738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4201 ST. ANTOINE UHC 5D MAILBOX# 226
Provider Second Line Business Mailing Address:
UNIVERSITY PEDIATRICIANS
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-966-5051
Provider Business Mailing Address Fax Number:
313-966-0665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 BEAUBIEN
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF MI
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-745-1436
Provider Business Practice Location Address Fax Number:
313-745-5867
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  35.085506 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 4301085471 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: 4301085471 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4900957 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000487858 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2621167 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7724838 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5211198 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05227 . This is a "PARAMOUNT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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