Provider Demographics
NPI:1568464485
Name:BHAGAT, JAGDISH B (MD)
Entity type:Individual
Prefix:DR
First Name:JAGDISH
Middle Name:B
Last Name:BHAGAT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:G1071 N BALLENGER HIGHWAY
Mailing Address - Street 2:PARK PLAZA SUITE 206
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4453
Mailing Address - Country:US
Mailing Address - Phone:810-234-1651
Mailing Address - Fax:810-424-3912
Practice Address - Street 1:G1071 N BALLENGER HIGHWAY
Practice Address - Street 2:PARK PLAZA SUITE 206
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4453
Practice Address - Country:US
Practice Address - Phone:810-234-1651
Practice Address - Fax:810-424-3912
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301032033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1036607Medicaid
MI1036607Medicaid
0259952Medicare ID - Type Unspecified