Provider Demographics
NPI:1215133228
Name:BHAN, ROMAL (MD)
Entity type:Individual
Prefix:DR
First Name:ROMAL
Middle Name:
Last Name:BHAN
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:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:4444 W BRISTOL RD
Practice Address - Street 2:STE 150
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3153
Practice Address - Country:US
Practice Address - Phone:810-230-9500
Practice Address - Fax:810-230-0169
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068770207R00000X, 207RI0200X
IN01088127A207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301068770OtherSTATE LICENSE