Provider Demographics
NPI:1598738692
Name:KANANI, BHARGAV (MD)
Entity Type:Individual
Prefix:MR
First Name:BHARGAV
Middle Name:
Last Name:KANANI
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 1:210 HOSPITAL LN
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1276
Mailing Address - Country:US
Mailing Address - Phone:573-517-0999
Mailing Address - Fax:573-517-0812
Practice Address - Street 1:210 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1276
Practice Address - Country:US
Practice Address - Phone:573-517-0999
Practice Address - Fax:573-517-0812
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO105937208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO12502274OtherUHC
MO50255OtherGHP
MO78303300457OtherAETNA
MO999557OtherCOMMUNITY CARE PLUS
MO111538OtherBCBS
MO50255OtherHEALTHCARE USA
MO50555OtherPRINCIPAL
MO281569OtherHEALTHLINK
MO208714709Medicaid
MO50555OtherPRINCIPAL