Provider Demographics
NPI:1669571592
Name:BHATT, JYOTI J (MD)
Entity type:Individual
Prefix:DR
First Name:JYOTI
Middle Name:J
Last Name:BHATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:216-383-5303
Mailing Address - Fax:216-383-5309
Practice Address - Street 1:18599 LAKESHORE BLVD
Practice Address - Street 2:#200
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119
Practice Address - Country:US
Practice Address - Phone:216-383-5303
Practice Address - Fax:216-383-5309
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064942207R00000X
OH35.064942207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0936394Medicaid
OHF65774Medicare UPIN
OH0747726Medicare PIN