Provider Demographics
NPI:1083053557
Name:BHAGAT, HEMAL MADHUSUDAN (RPT)
Entity Type:Individual
Prefix:
First Name:HEMAL
Middle Name:MADHUSUDAN
Last Name:BHAGAT
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11685 SQUIERS BLVD
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5936
Mailing Address - Country:US
Mailing Address - Phone:248-678-5042
Mailing Address - Fax:
Practice Address - Street 1:11685 SQUIERS BLVD
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48315-5936
Practice Address - Country:US
Practice Address - Phone:248-678-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist