Healthcare Provider Details

I. General information

NPI: 1922428143
Provider Name (Legal Business Name): BHASKAR BHARDWAJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 N RIVERSIDE RD STE 100
SAINT JOSEPH MO
64507
US

IV. Provider business mailing address

902 N RIVERSIDE RD STE 100
SAINT JOSEPH MO
64507-2566
US

V. Phone/Fax

Practice location:
  • Phone: 816-271-1241
  • Fax: 816-279-7794
Mailing address:
  • Phone: 816-271-1241
  • Fax: 816-279-7794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD205247
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD205247
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD205247
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number2024015243
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: