Provider Demographics
NPI:1386694230
Name:BHAGWAT, RAVI S (MD)
Entity type:Individual
Prefix:DR
First Name:RAVI
Middle Name:S
Last Name:BHAGWAT
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 1:10010 DONALD POWERS DRIVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-934-4200
Mailing Address - Fax:219-934-6240
Practice Address - Street 1:10010 DONALD POWERS DRIVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-934-4200
Practice Address - Fax:219-934-6240
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035958A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200103460AMedicaid
IN707050DMedicare PIN
INE03799Medicare UPIN