Provider Demographics
NPI:1194788158
Name:BHASKAR, SHYAM (MD)
Entity type:Individual
Prefix:DR
First Name:SHYAM
Middle Name:
Last Name:BHASKAR
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 1:231 W NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2631
Mailing Address - Country:US
Mailing Address - Phone:559-635-7100
Mailing Address - Fax:559-635-7104
Practice Address - Street 1:231 W NOBLE AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-2631
Practice Address - Country:US
Practice Address - Phone:559-635-7100
Practice Address - Fax:559-634-7104
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74116207RH0002X, 208000000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA74116OtherSTATE LICENSE
CAH89399Medicare UPIN
ZZZ07017ZMedicare PIN