Provider Demographics
NPI:1558338392
Name:BHATT, NILAKSHA (MD)
Entity Type:Individual
Prefix:
First Name:NILAKSHA
Middle Name:
Last Name:BHATT
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 1:1050 E 2ND ST
Mailing Address - Street 2:#235
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5313
Mailing Address - Country:US
Mailing Address - Phone:405-715-3610
Mailing Address - Fax:405-715-3612
Practice Address - Street 1:1050 E 2ND ST
Practice Address - Street 2:#235
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5313
Practice Address - Country:US
Practice Address - Phone:405-715-3610
Practice Address - Fax:405-715-3612
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18690207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1000139904AMedicaid
G02566Medicare UPIN