Provider Demographics
NPI:1669702155
Name:NAGINANI, BHAVANI (MD)
Entity type:Individual
Prefix:DR
First Name:BHAVANI
Middle Name:
Last Name:NAGINANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BHAVANI
Other - Middle Name:
Other - Last Name:VUNNAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003-3630
Mailing Address - Country:US
Mailing Address - Phone:928-522-9879
Mailing Address - Fax:
Practice Address - Street 1:2585 MIRACLE MILE STE 116
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7562
Practice Address - Country:US
Practice Address - Phone:928-704-1221
Practice Address - Fax:928-704-1236
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17387207Q00000X
IN01067230A207Q00000X
AZ43036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine