Provider Demographics
NPI:1982664926
Name:PITHADIA, BHARAT K (MD)
Entity Type:Individual
Prefix:
First Name:BHARAT
Middle Name:K
Last Name:PITHADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 LEONARD DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7136
Mailing Address - Country:US
Mailing Address - Phone:219-476-1704
Mailing Address - Fax:219-476-1704
Practice Address - Street 1:2801 LEONARD DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7136
Practice Address - Country:US
Practice Address - Phone:219-476-1704
Practice Address - Fax:219-476-1704
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033172A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100225200BMedicaid
IN080005104Medicare PIN
IN144250Medicare PIN
C25602Medicare UPIN