Provider Demographics
NPI:1295830495
Name:BRAHMBHATT, NAISHADH (MD)
Entity type:Individual
Prefix:
First Name:NAISHADH
Middle Name:
Last Name:BRAHMBHATT
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 1:1820 N KIMBALL AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4004
Mailing Address - Country:US
Mailing Address - Phone:630-379-3544
Mailing Address - Fax:630-379-3544
Practice Address - Street 1:1001 ROBBIE MINCE WAY
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2012
Practice Address - Country:US
Practice Address - Phone:972-353-7252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2743207RC0200X, 207RS0012X, 207RP1001X, 207RP1001X, 207RS0012X, 207RC0200X
IL036116975207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherBCBSTX
TXPENDINGMedicaid