Provider Demographics
NPI:1083949630
Name:PATEL, BHAVESHKUMAR J (RPT)
Entity Type:Individual
Prefix:MR
First Name:BHAVESHKUMAR
Middle Name:J
Last Name:PATEL
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 1:752 HIDDEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-5127
Mailing Address - Country:US
Mailing Address - Phone:989-560-0123
Mailing Address - Fax:
Practice Address - Street 1:20555 VICTOR PKWY
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-7031
Practice Address - Country:US
Practice Address - Phone:734-343-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501013441OtherSTATE OF MICHIGAN