Provider Demographics
NPI:1568418358
Name:AGRAWAL, BHARAT L (MD)
Entity Type:Individual
Prefix:
First Name:BHARAT
Middle Name:L
Last Name:AGRAWAL
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 1:200 N PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3731
Mailing Address - Country:US
Mailing Address - Phone:269-373-7449
Mailing Address - Fax:269-373-0123
Practice Address - Street 1:200 N PARK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-3731
Practice Address - Country:US
Practice Address - Phone:269-373-7449
Practice Address - Fax:269-373-0123
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034223A207RH0003X
OH35-05-4332A207RH0003X
MI4301035671207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1568418358Medicaid
IN100256820Medicaid
MI1447261730OtherBCBSM - WMCC
OH636128Medicaid
OH636128Medicaid
MIN66660023 - WMCCMedicare PIN
MI1447261730OtherBCBSM - WMCC
OHAG0687172Medicare ID - Type Unspecified