Basic Information
| Provider Information | |||||||||
| NPI: | 1104168269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHAVAN | ||||||||
| FirstName: | AMIT | ||||||||
| MiddleName: | ISHWAR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8701 W WATERTOWN PLANK RD | ||||||||
| Address2: | DEPARTMENT OF PSYCHIATRY & BEHAVIORAL MEDICINE | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149558998 | ||||||||
| FaxNumber: | 4149556299 | ||||||||
| Practice Location | |||||||||
| Address1: | 8701 W WATERTOWN PLANK RD | ||||||||
| Address2: | DEPARTMENT OF PSYCHIATRY & BEHAVIORAL MEDICINE | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532263548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149558998 | ||||||||
| FaxNumber: | 4149556299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2013 | ||||||||
| LastUpdateDate: | 09/08/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 62680-20 | WI | N | Allopathic & Osteopathic Physicians | General Practice | 2084P0800X | 62680-20 | WI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.