Healthcare Provider Details

I. General information

NPI: 1982664926
Provider Name (Legal Business Name): BHARAT K PITHADIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 LEONARD DR
VALPARAISO IN
46383-7136
US

IV. Provider business mailing address

2801 LEONARD DR
VALPARAISO IN
46383-7136
US

V. Phone/Fax

Practice location:
  • Phone: 219-476-1704
  • Fax: 219-476-1704
Mailing address:
  • Phone: 219-476-1703
  • Fax: 219-476-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01033172A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01033172A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: