Provider Demographics
NPI:1851385876
Name:BHATNAGAR, SHILPA (M D)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:
Last Name:BHATNAGAR
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2153 E BASELINE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1545
Mailing Address - Country:US
Mailing Address - Phone:480-820-1855
Mailing Address - Fax:480-820-8451
Practice Address - Street 1:2153 E BASELINE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1545
Practice Address - Country:US
Practice Address - Phone:480-820-1855
Practice Address - Fax:480-820-8451
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ365925Medicaid
AZ365925Medicaid
AZG41295Medicare UPIN