Healthcare Provider Details

I. General information

NPI: 1154531952
Provider Name (Legal Business Name): SUVEER DEEPAK BAGWE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

IV. Provider business mailing address

7190 FERNRIDGE DR
NEW ALBANY OH
43054-8423
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-2000
  • Fax:
Mailing address:
  • Phone: 612-868-3142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number35.152141
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number54038
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: