Provider Demographics
NPI:1174799043
Name:BHATT, PRAKSHEP B (MD)
Entity type:Individual
Prefix:DR
First Name:PRAKSHEP
Middle Name:B
Last Name:BHATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:SOMERTON
Mailing Address - State:AZ
Mailing Address - Zip Code:85350-0617
Mailing Address - Country:US
Mailing Address - Phone:928-315-7910
Mailing Address - Fax:928-722-6113
Practice Address - Street 1:151 S OAK AVE STE 2
Practice Address - Street 2:
Practice Address - City:SAN LUIS
Practice Address - State:AZ
Practice Address - Zip Code:85336-0756
Practice Address - Country:US
Practice Address - Phone:928-662-0414
Practice Address - Fax:928-722-6113
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54778-020207R00000X
AZ49397207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ956888Medicaid
AZ956888Medicaid