Provider Demographics
NPI:1326039652
Name:BHARGAVA, SHOBHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOBHANA
Middle Name:
Last Name:BHARGAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:KS
Mailing Address - Zip Code:67548-9673
Mailing Address - Country:US
Mailing Address - Phone:785-222-2564
Mailing Address - Fax:785-222-2629
Practice Address - Street 1:817 LOCUST ST
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:KS
Practice Address - Zip Code:67548-9673
Practice Address - Country:US
Practice Address - Phone:785-222-2564
Practice Address - Fax:785-222-2629
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18788173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB68529Medicare UPIN
KS001392Medicare ID - Type Unspecified