Healthcare Provider Details

I. General information

NPI: 1992084750
Provider Name (Legal Business Name): ANAND KRISHNA BHAT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 E BERT KOUNS INDUSTRIAL LOOP STE 106
SHREVEPORT LA
71105-5634
US

IV. Provider business mailing address

1455 E BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT LA
71105-6000
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-4573
  • Fax: 318-798-4651
Mailing address:
  • Phone: 318-798-4539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number322622
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.121131
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number322622
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number322622
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: