Provider Demographics
NPI:1871117549
Name:BAGWE, ASHLESHA RAVINDRA (MD)
Entity type:Individual
Prefix:DR
First Name:ASHLESHA
Middle Name:RAVINDRA
Last Name:BAGWE
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:PEDIATRICS RESIDENCY PROGRAM
Mailing Address - Street 2:1305 W 18TH ST, RT 6364
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105
Mailing Address - Country:US
Mailing Address - Phone:605-333-7197
Mailing Address - Fax:
Practice Address - Street 1:PEDIATRICS RESIDENCY PROGRAM
Practice Address - Street 2:1305 W 18TH ST, RT 6364
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-333-7197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program