Provider Demographics
NPI:1447205810
Name:BHAVSAR, MARY (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BHAVSAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10961 CLUB WEST PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-5866
Mailing Address - Country:US
Mailing Address - Phone:764-571-7550
Mailing Address - Fax:763-253-4142
Practice Address - Street 1:10961 CLUB WEST PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-5866
Practice Address - Country:US
Practice Address - Phone:763-571-7550
Practice Address - Fax:763-253-4142
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-11-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN40243207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN939972100Medicaid
MN4602400002Medicare NSC
MN4602400003Medicare NSC
180001097Medicare ID - Type Unspecified
MNG21317Medicare UPIN
MN939972100Medicaid
MN4602400001Medicare NSC