Provider Demographics
NPI:1134145766
Name:BHAVNAGRI, JAMSHID (MD)
Entity Type:Individual
Prefix:
First Name:JAMSHID
Middle Name:
Last Name:BHAVNAGRI
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 1:43211 DALCOMA DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6309
Mailing Address - Country:US
Mailing Address - Phone:586-228-7075
Mailing Address - Fax:586-228-7095
Practice Address - Street 1:43211 DALCOMA DR
Practice Address - Street 2:SUITE 4
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-6309
Practice Address - Country:US
Practice Address - Phone:586-228-7075
Practice Address - Fax:586-228-7095
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301040663207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI207V00000XOtherTAXONOMY
MI4301040663OtherLICENSE
MI0P01130Medicare ID - Type Unspecified
MI4301040663OtherLICENSE