Provider Demographics
NPI:1184741142
Name:BIJOY HEGDE MD, PC
Entity type:Organization
Organization Name:BIJOY HEGDE MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BIJOY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-451-1500
Mailing Address - Street 1:2044 MADISON AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-4641
Mailing Address - Country:US
Mailing Address - Phone:618-451-1500
Mailing Address - Fax:
Practice Address - Street 1:2044 MADISON AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4641
Practice Address - Country:US
Practice Address - Phone:618-451-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6032070OtherBC BS
MO000014117Medicare ID - Type Unspecified
IL206572Medicare ID - Type Unspecified