Healthcare Provider Details

I. General information

NPI: 1053305714
Provider Name (Legal Business Name): ASHWANI K BEDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SAINT MARYS DR STE 300
EVANSVILLE IN
47714-0521
US

IV. Provider business mailing address

901 SAINT MARYS DR STE 300
EVANSVILLE IN
47714-0521
US

V. Phone/Fax

Practice location:
  • Phone: 812-473-2642
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC143371
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01061814A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number40558
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberC143371
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number01061814A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: