Provider Demographics
NPI:1164482782
Name:BHARDWAJ, NIKHIL (MD)
Entity Type:Individual
Prefix:
First Name:NIKHIL
Middle Name:
Last Name:BHARDWAJ
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 1:1636 NE 194TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-6449
Mailing Address - Country:US
Mailing Address - Phone:305-792-7566
Mailing Address - Fax:
Practice Address - Street 1:21355 E DIXIE HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1238
Practice Address - Country:US
Practice Address - Phone:305-932-2552
Practice Address - Fax:305-932-2503
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 79930174400000X
FLME79930207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No174400000XOther Service ProvidersSpecialist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN191965OtherPREFERRED CARE
FLH12007OtherVISTA
FLUNITED HEALTHOther4800593
FL7469122OtherAETNA PROVIDER NUMBER
FL261864800Medicaid
FLN191965OtherWELLCARE
FL273491OtherAV MED
FL35713OtherBLUE CROSS BLUE SHIELD
FLN191965OtherSTAYWELL
FL39509OtherNEIGHBORHOOD
FLN191965OtherSTAYWELL
FL35713OtherBLUE CROSS BLUE SHIELD