Provider Demographics
NPI:1528018249
Name:BHOJRAJ, DEEPAK GOVIND (MD)
Entity Type:Individual
Prefix:
First Name:DEEPAK
Middle Name:GOVIND
Last Name:BHOJRAJ
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 1:3586 N HOBART RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-1442
Mailing Address - Country:US
Mailing Address - Phone:219-962-6500
Mailing Address - Fax:219-965-3853
Practice Address - Street 1:3586 N HOBART RD
Practice Address - Street 2:SUITE C
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-1442
Practice Address - Country:US
Practice Address - Phone:219-962-6500
Practice Address - Fax:219-965-3853
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029381A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100166380AMedicaid
492500Medicare ID - Type Unspecified
IN100166380AMedicaid