Provider Demographics
NPI:1396942124
Name:JAYSHREE S BHATT MD PC
Entity type:Organization
Organization Name:JAYSHREE S BHATT MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYSHREE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-836-0445
Mailing Address - Street 1:9124 COLUMBIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2907
Mailing Address - Country:US
Mailing Address - Phone:219-836-0445
Mailing Address - Fax:219-836-0463
Practice Address - Street 1:9124 COLUMBIA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2907
Practice Address - Country:US
Practice Address - Phone:219-836-0445
Practice Address - Fax:219-836-0463
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAYSHREE S BHATT MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-27
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033072207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1831106186OtherINDIVIDUAL NPI
IN080185321OtherRAILROAD MEDICARE
INC25454Medicare UPIN
IN703100Medicare ID - Type UnspecifiedMEDICARE
IN1831106186OtherINDIVIDUAL NPI