Provider Demographics
NPI:1598798589
Name:BHAVSAR, DHANANJAY (MD)
Entity Type:Individual
Prefix:
First Name:DHANANJAY
Middle Name:
Last Name:BHAVSAR
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 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3513
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:2101 DUBOIS DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3210
Practice Address - Country:US
Practice Address - Phone:574-267-3200
Practice Address - Fax:574-372-7649
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35095548207R00000X, 208M00000X
MDD0061719207R00000X
IN01085302A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300048875Medicaid
OH000000664716OtherANTHEM
OH3058471Medicaid
MDI16748Medicare UPIN
OHH79674Medicare PIN
MDI16748Medicare UPIN