Provider Demographics
NPI:1831106186
Name:BHATT, JAYSHREE S (MD PC)
Entity Type:Individual
Prefix:
First Name:JAYSHREE
Middle Name:S
Last Name:BHATT
Suffix:
Gender:F
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9124 COLUMBIA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2907
Mailing Address - Country:US
Mailing Address - Phone:219-836-0445
Mailing Address - Fax:219-836-0463
Practice Address - Street 1:9124 COLUMBIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-836-0445
Practice Address - Fax:219-836-0463
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1396942124OtherMEDICARE RAILROAD
IN703100OtherMEDICARE
IN1831106186OtherINDIVIDUAL NPI
INP00731929OtherMEDICARE RAILROAD
IN1831106186OtherINDIVIDUAL NPI
INC25454Medicare UPIN