Provider Demographics
NPI:1447239041
Name:KATBAMNA, BHAGIRATH H (MD)
Entity Type:Individual
Prefix:DR
First Name:BHAGIRATH
Middle Name:H
Last Name:KATBAMNA
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 1:100 MEDICAL DR
Mailing Address - Street 2:P.O. BOX 311
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6877
Mailing Address - Country:US
Mailing Address - Phone:573-231-3128
Mailing Address - Fax:573-231-3726
Practice Address - Street 1:100 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-6877
Practice Address - Country:US
Practice Address - Phone:573-231-3128
Practice Address - Fax:573-231-3726
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113592207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208875005Medicaid
MO015013772Medicare ID - Type Unspecified
MO208875005Medicaid