Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 01082457A | IN |
NPI | 1043567886 |
---|---|
Provider Name | Dr. Bharat Bajantri |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2012 |
Last Update Date | 25/03/2021 |