Provider Demographics
NPI:1720254923
Name:BHAVSAR, SHRIPAL KANTILAL (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:SHRIPAL
Middle Name:KANTILAL
Last Name:BHAVSAR
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 248856
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73124-8856
Mailing Address - Country:US
Mailing Address - Phone:405-607-4520
Mailing Address - Fax:405-896-9870
Practice Address - Street 1:5911 W MEMORIAL RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2015
Practice Address - Country:US
Practice Address - Phone:405-773-6530
Practice Address - Fax:405-621-5435
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK297212085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK314568YU3UMedicare PIN