Provider Demographics
NPI:1083929269
Name:BAVLE, ABHISHEK AMAR (MD)
Entity Type:Individual
Prefix:
First Name:ABHISHEK
Middle Name:AMAR
Last Name:BAVLE
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 1:1301 BARBARA JORDAN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3078
Mailing Address - Country:US
Mailing Address - Phone:512-628-1900
Mailing Address - Fax:
Practice Address - Street 1:1301 BARBARA JORDAN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3078
Practice Address - Country:US
Practice Address - Phone:512-628-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-12
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS61292080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX417892301Medicaid