Provider Demographics
NPI:1154522472
Name:BHATT, ARCHANA (MD)
Entity type:Individual
Prefix:
First Name:ARCHANA
Middle Name:
Last Name:BHATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ARCHANA
Other - Middle Name:
Other - Last Name:PRABHAKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-364-5260
Mailing Address - Fax:517-364-5251
Practice Address - Street 1:1200 E MICHIGAN AVE STE 520
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1899
Practice Address - Country:US
Practice Address - Phone:517-364-5260
Practice Address - Fax:517-364-5251
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301113720208100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation