=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669406807
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VISHWAJIT BRAHMBHATT MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2006
-----------------------------------------------------
Last Update Date | 01/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 HIGHLAND RD STE 1
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47374-8810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-935-8905
-----------------------------------------------------
Fax | 765-939-4200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1100 REID PARKWAY MEDICAL STAFF SERVICES
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47374-1157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-983-3219
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 01050386
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------