Provider Demographics
NPI:1558366468
Name:BHANDARI, JITENDER P (MD)
Entity Type:Individual
Prefix:
First Name:JITENDER
Middle Name:P
Last Name:BHANDARI
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 1:550 LANDMARK AVE
Mailing Address - Street 2:PO BOX 550
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-0550
Mailing Address - Country:US
Mailing Address - Phone:812-333-5973
Mailing Address - Fax:812-330-3681
Practice Address - Street 1:550 S LANDMARK AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3239
Practice Address - Country:US
Practice Address - Phone:812-333-5973
Practice Address - Fax:812-330-3681
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039232A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100355860Medicaid
IN100355860Medicaid
INM400021613Medicare PIN
INM400021613Medicare PIN