Healthcare Provider Details

I. General information

NPI: 1669406807
Provider Name (Legal Business Name): VISHWAJIT BRAHMBHATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/09/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HIGHLAND RD STE 1
RICHMOND IN
47374-8810
US

IV. Provider business mailing address

1100 REID PARKWAY MEDICAL STAFF SERVICES
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-8905
  • Fax: 765-939-4200
Mailing address:
  • Phone: 765-983-3219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number01050386
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: