Provider Demographics
NPI:1811906555
Name:BHATOYA, JAGDEV R (MD)
Entity type:Individual
Prefix:DR
First Name:JAGDEV
Middle Name:R
Last Name:BHATOYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAGDEV
Other - Middle Name:RAJ
Other - Last Name:BHATOYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:420 E DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-4560
Mailing Address - Country:US
Mailing Address - Phone:920-926-8340
Mailing Address - Fax:920-926-8370
Practice Address - Street 1:620 W BROWN ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-1702
Practice Address - Country:US
Practice Address - Phone:920-926-8332
Practice Address - Fax:920-926-8370
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34203208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11014110Medicaid
WI390848401050OtherANTHEM
WI1326349135OtherCMH SB NPI
WI1851477913OtherNPI CMH
WI31964300Medicaid
WI31964300Medicaid
BB3699660OtherDEA NUMBER
WI390848401050OtherANTHEM
WI52Z310Medicare Oscar/Certification