Provider Demographics
NPI:1427430677
Name:BHAVANA VYAS MD PLLC
Entity type:Organization
Organization Name:BHAVANA VYAS MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-263-1818
Mailing Address - Street 1:43475 DALCOMA DR STE 208
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-3593
Mailing Address - Country:US
Mailing Address - Phone:586-263-1818
Mailing Address - Fax:586-314-6044
Practice Address - Street 1:43475 DALCOMA DR STE 208
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-3593
Practice Address - Country:US
Practice Address - Phone:586-263-1818
Practice Address - Fax:586-314-6044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-24
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty