Provider Demographics
NPI:1558472605
Name:MUKESH BHATT MD INC
Entity Type:Organization
Organization Name:MUKESH BHATT MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MUKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-722-5422
Mailing Address - Street 1:970 E WASHINGTON ST
Mailing Address - Street 2:STE 4 D
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3332
Mailing Address - Country:US
Mailing Address - Phone:330-722-5422
Mailing Address - Fax:330-722-8396
Practice Address - Street 1:970 E WASHINGTON ST
Practice Address - Street 2:STE 4 D
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3332
Practice Address - Country:US
Practice Address - Phone:330-722-5422
Practice Address - Fax:330-722-8396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57526174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0784325Medicaid
OHDE0848Medicare PIN
OHE41990Medicare UPIN
OH0784325Medicaid