Basic Information
| Provider Information | |||||||||
| NPI: | 1124231204 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAVISHI | ||||||||
| FirstName: | SAMEER | ||||||||
| MiddleName: | BIPIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 S 6TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478074214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423157 | ||||||||
| FaxNumber: | 8122423861 | ||||||||
| Practice Location | |||||||||
| Address1: | 1725 N 5TH ST | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478044010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122423005 | ||||||||
| FaxNumber: | 8122423054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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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 | 207X00000X | 036-117902 | IL | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 01065088A | IN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00718153 | 01 | IN | RAILROAD MEDICARE | OTHER | P00834671 | 01 | IN | RAILROAD MEDICARE | OTHER |