Provider Demographics
NPI:1326575416
Name:BHATIA, ANKIT KUMAR (DO)
Entity Type:Individual
Prefix:
First Name:ANKIT
Middle Name:KUMAR
Last Name:BHATIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5501 W BETHEL AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-8513
Practice Address - Country:US
Practice Address - Phone:765-741-2957
Practice Address - Fax:765-747-3310
Is Sole Proprietor?:No
Enumeration Date:2017-05-19
Last Update Date:2022-06-02
Deactivation Date:2017-12-21
Deactivation Code:
Reactivation Date:2018-01-04
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN02006641A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program