Provider Demographics
NPI:1518960525
Name:BHAGAT, DICKY GIRISH (MD)
Entity Type:Individual
Prefix:DR
First Name:DICKY
Middle Name:GIRISH
Last Name:BHAGAT
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 1:2240 KARISA DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6943
Mailing Address - Country:US
Mailing Address - Phone:574-534-6757
Mailing Address - Fax:574-537-0357
Practice Address - Street 1:2240 KARISA DR
Practice Address - Street 2:SUITE 1
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6943
Practice Address - Country:US
Practice Address - Phone:574-534-6757
Practice Address - Fax:574-537-0357
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054743A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000322073OtherANTHEM PROVIDER NO.
IN200323890AMedicaid
INH43487Medicare UPIN
IN213940AMedicare ID - Type Unspecified