Provider Demographics
NPI:1932429917
Name:BHAMBHANI, VIKAS (MD)
Entity Type:Individual
Prefix:DR
First Name:VIKAS
Middle Name:
Last Name:BHAMBHANI
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 1:5901 LINCOLN DRIVE CBC-2-REV/PE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1611
Mailing Address - Country:US
Mailing Address - Phone:952-992-5624
Mailing Address - Fax:952-992-6917
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-7240
Practice Address - Fax:612-813-6360
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN56266207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)