Provider Demographics
NPI:1477507416
Name:BHATIA, SAMEER (MD)
Entity type:Individual
Prefix:
First Name:SAMEER
Middle Name:
Last Name:BHATIA
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 1:2400 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-3027
Mailing Address - Country:US
Mailing Address - Phone:765-446-4719
Mailing Address - Fax:765-446-4859
Practice Address - Street 1:2400 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3027
Practice Address - Country:US
Practice Address - Phone:765-446-4719
Practice Address - Fax:765-446-4859
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061400A2085R0202X, 2085R0204X
KY524672085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00414276OtherMEDICARE RAILROAD
IN000000523950OtherANTHEM
IN200813670Medicaid
IN200456580Medicaid
IN000000523950OtherANTHEM
IN200456580Medicaid
INP00414276OtherMEDICARE RAILROAD