Individual
SHAMIK BAFNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 GREENBUSH STREET, LAFAYETTE, IN 47904-2479
(765) 448-8000
(765) 448-8335
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 448-8335
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01046462A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000197817
ANTHEM PROVIDER NUMBER
IN
01
—
10824725
CAQH NUMBER
IN
05
—
200166010
—
IN
01
—
9396814
PHCS PID NUMBER
IN
Enumeration date
03/14/2006
Last updated
10/26/2020
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