Provider Demographics
NPI:1376540823
Name:BHAT, MADHAV H (MD)
Entity Type:Individual
Prefix:
First Name:MADHAV
Middle Name:H
Last Name:BHAT
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 1:250 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 1:2510 E DUPONT RD STE 226
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1603
Practice Address - Country:US
Practice Address - Phone:260-460-3100
Practice Address - Fax:260-460-3130
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034970A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0703537Medicaid
IN100319640Medicaid
IN130005974OtherRR MEDICARE
MI2717800Medicaid
IN5506830001Medicare NSC
OH0703537Medicaid
MI2717800Medicaid
IN130005974Medicare PIN
IN130005974OtherRR MEDICARE