Provider Demographics
NPI:1184606550
Name:BHAKTA, BHADRESH L (MD)
Entity type:Individual
Prefix:
First Name:BHADRESH
Middle Name:L
Last Name:BHAKTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8556 E 101ST ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7033
Mailing Address - Country:US
Mailing Address - Phone:918-369-5511
Mailing Address - Fax:918-369-5512
Practice Address - Street 1:8556 E 101ST ST
Practice Address - Street 2:SUITE A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-7033
Practice Address - Country:US
Practice Address - Phone:918-369-5511
Practice Address - Fax:918-369-5512
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK21668208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7902202OtherAETNA
OK7902202OtherAETNA