Basic Information
| Provider Information | |||||||||
| NPI: | 1598798589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHAVSAR | ||||||||
| FirstName: | DHANANJAY | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6920 POINTE INVERNESS WAY STE 200 | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468047934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2604793513 | ||||||||
| FaxNumber: | 2604793520 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 DUBOIS DR | ||||||||
| Address2: | |||||||||
| City: | WARSAW | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465803210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742673200 | ||||||||
| FaxNumber: | 5743727649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35095548 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | D0061719 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 35095548 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 01085302A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 300048875 | 05 | IN | MEDICAID | 000000664716 | 01 | OH | ANTHEM | OTHER | 3058471 | 05 | OH | MEDICAID |