Provider Demographics
NPI:1083714976
Name:BHARAT PATEL M.D. PC
Entity type:Organization
Organization Name:BHARAT PATEL M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BHARAT
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-776-8200
Mailing Address - Street 1:21420 HARPER AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3607
Mailing Address - Country:US
Mailing Address - Phone:586-776-8200
Mailing Address - Fax:586-776-8200
Practice Address - Street 1:21420 HARPER AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3607
Practice Address - Country:US
Practice Address - Phone:586-776-8200
Practice Address - Fax:586-776-8200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407611207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1105043052OtherBLUE CROSS BLUE SHIELD
MI2574780-10Medicaid
MI2574780-10Medicaid
MI1105043052OtherBLUE CROSS BLUE SHIELD
MI0504305Medicare ID - Type Unspecified