Provider Demographics
NPI:1578663951
Name:BHAVNANI, SANJEEV K (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJEEV
Middle Name:K
Last Name:BHAVNANI
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 1:9293 STATE ROUTE 43 STE B
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5376
Mailing Address - Country:US
Mailing Address - Phone:330-626-1113
Mailing Address - Fax:330-626-1133
Practice Address - Street 1:9293 STATE ROUTE 43 STE B
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5376
Practice Address - Country:US
Practice Address - Phone:330-626-1113
Practice Address - Fax:330-626-1133
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-079601207RG0300X
GA77555207RG0300X
OH35079601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2254895Medicaid
OH2254895Medicaid