Provider Demographics
NPI:1609814599
Name:BAVISHI, NILESH (MD)
Entity Type:Individual
Prefix:
First Name:NILESH
Middle Name:
Last Name:BAVISHI
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 1:7777 SOUTHWEST FWY
Mailing Address - Street 2:STE 544
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1802
Mailing Address - Country:US
Mailing Address - Phone:713-541-0000
Mailing Address - Fax:713-541-0087
Practice Address - Street 1:7777 SOUTHWEST FWY
Practice Address - Street 2:STE 544
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1802
Practice Address - Country:US
Practice Address - Phone:713-541-0000
Practice Address - Fax:713-541-0087
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK1777207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE63923Medicare UPIN
TX0035BKMedicare PIN