Healthcare Provider Details

I. General information

NPI: 1477507416
Provider Name (Legal Business Name): SAMEER BHATIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 SOUTH ST
LAFAYETTE IN
47904-3027
US

IV. Provider business mailing address

2400 SOUTH ST
LAFAYETTE IN
47904-3027
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-4719
  • Fax: 765-446-4859
Mailing address:
  • Phone: 765-446-4719
  • Fax: 765-446-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01061400A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number01061400A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number52467
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: