Provider Demographics
NPI:1184921645
Name:PINAKIN G. BHAKTA M.D.,P.C.
Entity type:Organization
Organization Name:PINAKIN G. BHAKTA M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEELABEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BHAKTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-978-5005
Mailing Address - Street 1:17100 N. 67TH AVE.
Mailing Address - Street 2:SUITE 602
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3605
Mailing Address - Country:US
Mailing Address - Phone:602-978-5005
Mailing Address - Fax:602-978-1115
Practice Address - Street 1:17100 N 67TH AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3605
Practice Address - Country:US
Practice Address - Phone:602-978-5005
Practice Address - Fax:602-978-1115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINAKIN G. BHAKTA M.D.,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ485434Medicaid
AZ485434Medicaid
AZZ65922Medicare PIN