Provider Demographics
NPI:1891803102
Name:BILGI, JAGADISH R (M D)
Entity Type:Individual
Prefix:
First Name:JAGADISH
Middle Name:R
Last Name:BILGI
Suffix:
Gender:M
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 1:2201 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-2484
Mailing Address - Country:US
Mailing Address - Phone:515-964-7117
Mailing Address - Fax:515-964-0660
Practice Address - Street 1:2201 W 1ST ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-2484
Practice Address - Country:US
Practice Address - Phone:515-964-7117
Practice Address - Fax:515-964-0660
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20835208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0145284Medicaid
IA0145284Medicaid