Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 23709 | KS |
N | 111NI0900X | Internist | 23709 | KS |
N | 207RC0000X | Internist - Cardiovascular Disease | 23709 | KS |
Y | 207RI0011X | Interventional Cardiology | 23709 | KS |
NPI | 1013909746 |
---|---|
Provider Name | Dr. Ravi K Bajaj |
First Address | Wichita, KS 67226-8127 |
Second Address | Wichita, KS 67226-8127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 23/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060026635 | RRMC (01) | KS |
100129790M | (05) | KS |
C71633 | (02) | |
KA3651010 | MEDICARE (01) | KS |