Provider Demographics
NPI:1194709956
Name:BAKSHI, SANJEEV (MD)
Entity type:Individual
Prefix:DR
First Name:SANJEEV
Middle Name:
Last Name:BAKSHI
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 3299
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-3299
Mailing Address - Country:US
Mailing Address - Phone:844-207-4039
Mailing Address - Fax:775-222-0056
Practice Address - Street 1:5505 S 900 E STE 240
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117
Practice Address - Country:US
Practice Address - Phone:801-783-5011
Practice Address - Fax:801-746-3734
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8947207R00000X, 208M00000X
NMMD2018-0428208M00000X
UT9300195-1205208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505248Medicaid
11444114OtherCAQH
NVDH777YMedicare PIN
NVV100225Medicare PIN
11444114OtherCAQH