Provider Demographics
NPI:1861677056
Name:MADHUMITA BHOJRAJ MD,PC
Entity Type:Organization
Organization Name:MADHUMITA BHOJRAJ MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADHUMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHOJRAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-887-8000
Mailing Address - Street 1:6111 HARRISON ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2969
Mailing Address - Country:US
Mailing Address - Phone:219-887-8000
Mailing Address - Fax:219-887-8815
Practice Address - Street 1:6111 HARRISON ST
Practice Address - Street 2:SUITE 225
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2969
Practice Address - Country:US
Practice Address - Phone:219-887-8000
Practice Address - Fax:219-887-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032331A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10780356OtherCAQH
IN226710AMedicare PIN
IN226710 GROUP NUMBERMedicare PIN
IN10780356OtherCAQH