MEDICARE: DR. MANU BHAKOO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	24302	OK
2	208000000X	Pediatrics Physician	37865	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7738422	OTHER	OK	AETNA

General Provider Information

NPI Number	:	1518952373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANU BHAKOO MD

Provider Business Mailing Address
First Line	:	PO BOX 16455
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85211-6455
Country	:	US
Telephone Number	:	480-962-0511
Fax Number	:	480-962-0523

Provider Business Practice Location Address
First Line	:	1075 S IDAHO RD
Second Line	:	SUITE 206
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85219-6496
Country	:	US
Telephone Number	:	480-889-1234
Fax Number	:	480-889-1235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	06/16/2011

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Directions to “ DR. MANU BHAKOO MD” Practice Location

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