Provider Demographics
NPI:1720345622
Name:DIPTI BAVISHI MD PLLC
Entity Type:Organization
Organization Name:DIPTI BAVISHI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DIPTI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAVISHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-541-0000
Mailing Address - Street 1:7777 SOUTHWEST FWY
Mailing Address - Street 2:STE 544
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-1802
Mailing Address - Country:US
Mailing Address - Phone:713-541-0000
Mailing Address - Fax:713-541-0087
Practice Address - Street 1:7777 SOUTHWEST FWY
Practice Address - Street 2:STE 544
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1802
Practice Address - Country:US
Practice Address - Phone:713-541-0000
Practice Address - Fax:713-541-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2413207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030119401Medicaid
1952348898OtherNPI
0034BKMedicare PIN
TX030119401Medicaid