Healthcare Provider Details

I. General information

NPI: 1174714299
Provider Name (Legal Business Name): BHAVIKA TRIVEDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BHAVIKA RUTESH DAVE M.D.

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 WENDOVER WAY
RIDGELAND MS
39157-4192
US

IV. Provider business mailing address

4040 E CAMELBACK RD STE 250
PHOENIX AZ
85018-8350
US

V. Phone/Fax

Practice location:
  • Phone: 917-586-7280
  • Fax:
Mailing address:
  • Phone: 855-687-7237
  • Fax: 855-673-9190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101274966
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number23310
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: