Provider Demographics
NPI:1780684142
Name:BHASIN, VIJAY KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:KUMAR
Last Name:BHASIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VIJAY
Other - Middle Name:K
Other - Last Name:BHASIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3801 BELLEMEADE AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3801 BELLEMEADE AVE
Practice Address - Street 2:STE 330
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0113
Practice Address - Country:US
Practice Address - Phone:812-479-3125
Practice Address - Fax:812-491-6491
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057474A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200423920Medicaid
KY64064835Medicaid
KY64064835Medicaid
INH28200Medicare UPIN
IN200423920Medicaid
IN637060LMedicare ID - Type Unspecified