Provider Demographics
NPI:1366023830
Name:BHATNAGAR, SHWETA (DO)
Entity type:Individual
Prefix:
First Name:SHWETA
Middle Name:
Last Name:BHATNAGAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 PATIENT CARE DR STE A
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4271
Mailing Address - Country:US
Mailing Address - Phone:517-374-7600
Mailing Address - Fax:855-495-5457
Practice Address - Street 1:3955 PATIENT CARE DR STE A
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4271
Practice Address - Country:US
Practice Address - Phone:517-374-7600
Practice Address - Fax:855-495-5457
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151015037390200000X
MI5101028140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program