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General NPI Number Information
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NPI Number | 1114910908
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Entity Type | Individual
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Provider Name | SHAMIK BHADRA MD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 08/22/2019
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Provider Practice Location Address
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Address Line | 3114 W BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640
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Country | US
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Telephone | 323-726-3868
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Fax | 323-726-3870
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Provider Business Mailing Address
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Address Line | 2149 E WARNER RD STE 102
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City | TEMPE
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State | AZ
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Zip | 85284-3495
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Country | US
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Telephone | 480-393-0309
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Fax | 480-610-6189
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A124360
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License Number State | CA
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