Provider Demographics
NPI:1659446300
Name:BHATIA, MONIKA ANIL (MD)
Entity type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:ANIL
Last Name:BHATIA
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 1:599 S CUSTER RD
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3105
Mailing Address - Country:US
Mailing Address - Phone:972-359-7600
Mailing Address - Fax:972-359-7601
Practice Address - Street 1:599 S CUSTER RD
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3105
Practice Address - Country:US
Practice Address - Phone:972-359-7600
Practice Address - Fax:972-359-7601
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8282208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0005PJOtherBCBS
TX172784403Medicaid
TX205898630OtherTAX ID
TX172784402Medicaid
TX0005PJOtherBCBS
TX172784402Medicaid