Provider Demographics
NPI:1720068208
Name:BASHYAKARLA, RAJEEVA K (MD)
Entity type:Individual
Prefix:DR
First Name:RAJEEVA
Middle Name:K
Last Name:BASHYAKARLA
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 1:1515 S CLIFTON AVE
Mailing Address - Street 2:#200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2900
Mailing Address - Country:US
Mailing Address - Phone:316-618-1515
Mailing Address - Fax:316-618-8635
Practice Address - Street 1:1515 S CLIFTON AVE
Practice Address - Street 2:#200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2900
Practice Address - Country:US
Practice Address - Phone:316-618-1515
Practice Address - Fax:316-618-8635
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-29069207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F73093Medicare UPIN
100880Medicare ID - Type Unspecified