Provider Demographics
NPI:1609063429
Name:SHYAM BHASKAR MD INC
Entity Type:Organization
Organization Name:SHYAM BHASKAR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BHASKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-635-7100
Mailing Address - Street 1:231 W NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2631
Mailing Address - Country:US
Mailing Address - Phone:559-635-7100
Mailing Address - Fax:559-635-7104
Practice Address - Street 1:231 W NOBLE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-2631
Practice Address - Country:US
Practice Address - Phone:559-635-7100
Practice Address - Fax:559-635-7104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH89399Medicare UPIN
ZZZ07017ZMedicare PIN