Provider Demographics
NPI:1043325186
Name:BACHHAWAT, REETU (MD)
Entity type:Individual
Prefix:DR
First Name:REETU
Middle Name:
Last Name:BACHHAWAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8101 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4696
Practice Address - Country:US
Practice Address - Phone:317-621-5390
Practice Address - Fax:317-621-7885
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55079207R00000X, 208M00000X
WV25727208M00000X
IA36674208M00000X
IN01076795A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043325186Medicaid
IA28711OtherBLUE CROSS BLUE SHIELD
IAP00466186OtherRAILROAD MC
IN201369820Medicaid
INP01723959OtherRR MEDICARE
IA0725366Medicaid
CAGC145ZMedicare PIN
IAP00466186OtherRAILROAD MC
IN266180705Medicare PIN
IAI18330Medicare PIN