Provider Demographics
NPI:1013958867
Name:BHAVSAR, MADHUMALTI D (MD)
Entity Type:Individual
Prefix:DR
First Name:MADHUMALTI
Middle Name:D
Last Name:BHAVSAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MADHUMALTI
Other - Middle Name:D
Other - Last Name:BHAVSAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3100 CHINO HILLS PKWY UNIT 823
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4289
Mailing Address - Country:US
Mailing Address - Phone:734-717-1555
Mailing Address - Fax:
Practice Address - Street 1:8710 MONROE CT STE 150
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-4885
Practice Address - Country:US
Practice Address - Phone:909-941-4870
Practice Address - Fax:909-941-4875
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010681932084A0401X
CAC1463762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2607900572OtherBLUE CROSS BLUE SHIELD
MI10-4962501Medicaid
MI260049251OtherRAILROAD MEDICARE GOURP C
MIM38660012Medicare PIN
MI260049251OtherRAILROAD MEDICARE GOURP C
MI10-4962501Medicaid