Provider Demographics
NPI:1326026154
Name:BHATT, MUKESH C (MD)
Entity type:Individual
Prefix:
First Name:MUKESH
Middle Name:C
Last Name:BHATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:970 E WASHINGTON ST
Mailing Address - Street 2:SUITE 4 D
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3332
Mailing Address - Country:US
Mailing Address - Phone:330-722-5422
Mailing Address - Fax:330-722-8396
Practice Address - Street 1:970 E WASHINGTON ST
Practice Address - Street 2:SUITE 4 D
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3332
Practice Address - Country:US
Practice Address - Phone:330-722-5422
Practice Address - Fax:330-722-8396
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH57826207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0784325Medicaid
OHBH0666853Medicare ID - Type Unspecified
OHE41990Medicare UPIN