Provider Demographics
NPI:1417929175
Name:BHATNAGAR, PANKAJ K (MD)
Entity Type:Individual
Prefix:
First Name:PANKAJ
Middle Name:K
Last Name:BHATNAGAR
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:PO BOX 35197
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5197
Mailing Address - Country:US
Mailing Address - Phone:702-791-7855
Mailing Address - Fax:702-791-7859
Practice Address - Street 1:6850 N DURANGO DR
Practice Address - Street 2:SUITE 204
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4595
Practice Address - Country:US
Practice Address - Phone:702-791-7855
Practice Address - Fax:702-791-7859
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12469208600000X
IL036104967208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1417929175Medicaid
NV1417929175Medicaid
G11431Medicare UPIN
NVV105785Medicare PIN