Provider Demographics
NPI:1619943388
Name:BHIMANI, JAYANTILAL D (MD)
Entity type:Individual
Prefix:
First Name:JAYANTILAL
Middle Name:D
Last Name:BHIMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:1730 W 25TH ST STE 2E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3108
Practice Address - Country:US
Practice Address - Phone:216-696-4140
Practice Address - Fax:216-363-2058
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067464B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D368301OtherGROUP IND DIAGNOSTICS MED
F67464OtherSUMMACARE APEX
10788628OtherCAQH
9273172OtherGROUP MEDICARE
OH0102285Medicaid
110203325OtherRR MEDICARE INDIVIDUAL
341783789065OtherCARESOURCE
0402766OtherUNITED HEALTHCARE
3610861OtherGROUP ASC MEDICARE
000000183955OtherANTHEM
107754OtherKAISER
1780634279OtherGROUP NPI
0119204OtherGROUP MEDICAID
CA4511OtherGROUP RR MEDICARE
2212325OtherAETNA
F67464OtherSUMMACARE APEX
34-1783789OtherGROUP TIN
F67464OtherSUMMACARE APEX