Healthcare Provider Details

I. General information

NPI: 1952527442
Provider Name (Legal Business Name): TARUN BHARGAVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 12/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 N WEBB RD
WICHITA KS
67206-3405
US

IV. Provider business mailing address

1923 N WEBB RD
WICHITA KS
67206-3405
US

V. Phone/Fax

Practice location:
  • Phone: 316-262-4886
  • Fax: 316-262-4887
Mailing address:
  • Phone: 316-262-4886
  • Fax: 316-262-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0430804
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number04-30804
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: