Healthcare Provider Details

I. General information

NPI: 1598738692
Provider Name (Legal Business Name): BHARGAV KANANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 HOSPITAL LN
PERRYVILLE MO
63775-1276
US

IV. Provider business mailing address

210 HOSPITAL LN
PERRYVILLE MO
63775-1276
US

V. Phone/Fax

Practice location:
  • Phone: 573-517-0999
  • Fax: 573-517-0812
Mailing address:
  • Phone: 573-517-0999
  • Fax: 573-517-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMO105937
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: