Provider Demographics
NPI:1003869439
Name:BHUSHAN, VIKAS (MD)
Entity Type:Individual
Prefix:
First Name:VIKAS
Middle Name:
Last Name:BHUSHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1888
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403
Mailing Address - Country:US
Mailing Address - Phone:800-945-2455
Mailing Address - Fax:770-237-1831
Practice Address - Street 1:7710T CHERRY PARK DR # 522
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2725
Practice Address - Country:US
Practice Address - Phone:877-572-8456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL39212085R0202X
ARE42602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200101060AMedicaid
TX154218506Medicaid
TX154218503Medicaid
MO1003869439Medicaid
AR161954001Medicaid
NM23381256Medicaid
TX300137512Medicare PIN
TX8A1349Medicare PIN
TX154218506Medicaid
NM23381256Medicaid
G66110Medicare UPIN
TX154218503Medicaid