Provider Demographics
NPI:1215187042
Name:BHAGAT, ANITA D (MD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:D
Last Name:BHAGAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:D
Other - Last Name:BHAGAT PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-9748
Mailing Address - Fax:317-355-8716
Practice Address - Street 1:11501 CUMBERLAND ROAD
Practice Address - Street 2:SUITE 500
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7010
Practice Address - Country:US
Practice Address - Phone:317-621-9393
Practice Address - Fax:317-621-9383
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068607A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400025239Medicare PIN
INM400046114Medicare PIN