Individual
DIVYESH R BHAKTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6420 DUTCHMANS PKWY, SUITE 200, LOUISVILLE, KY 40205-3372
(502) 891-8300
(502) 891-8338
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
31873
KY
207RI0011X
Interventional Cardiology Physician
Primary
31873
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000290262
ANTHEM PIN
KY
01
—
000000693029
ANTHEM - NCVA
KY
01
—
000057058Y
HUMANA - NCVA
KY
05
—
200423300A
—
IN
05
—
200423300F
—
IN
01
—
2442264000
PASSPORT ADVANTAGE
KY
01
—
50000584
PASSPORT PIN
KY
05
—
64036544
—
KY
01
—
P00893023
RAILROAD MEDICARE - NCVA
KY
Enumeration date
06/25/2006
Last updated
01/12/2021
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