Provider Demographics
NPI:1427128065
Name:BIG RAPIDS UROLOGY CENTER PC
Entity type:Organization
Organization Name:BIG RAPIDS UROLOGY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRINDER
Authorized Official - Middle Name:K
Authorized Official - Last Name:BHARDWAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-796-4700
Mailing Address - Street 1:123 S WARREN
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307
Mailing Address - Country:US
Mailing Address - Phone:231-796-4700
Mailing Address - Fax:231-796-3577
Practice Address - Street 1:123 S WARREN
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307
Practice Address - Country:US
Practice Address - Phone:231-796-4700
Practice Address - Fax:231-796-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044214208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3405400531OtherBCBS
MI4355774Medicaid
MI3405400531OtherBCBS
MI4355774Medicaid