Provider Demographics
NPI:1669705091
Name:YADIKI, BHANU PRAKASH (MD)
Entity type:Individual
Prefix:DR
First Name:BHANU PRAKASH
Middle Name:
Last Name:YADIKI
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:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45343-0229
Mailing Address - Country:US
Mailing Address - Phone:513-894-0486
Mailing Address - Fax:
Practice Address - Street 1:6730 ROOSEVELT AVE STE 303
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005
Practice Address - Country:US
Practice Address - Phone:513-874-0486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27163208M00000X, 207Q00000X
OH35-146420208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100535230Medicaid
WV1669705091Medicaid
OH0287260Medicaid