Provider Demographics
NPI:1144383761
Name:BHANDARKAR, PRADEEP SRINIVAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PRADEEP
Middle Name:SRINIVAS
Last Name:BHANDARKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM
Mailing Address - Street 2:19401 HUBBARD DRIVE,SUITE #107
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126
Mailing Address - Country:US
Mailing Address - Phone:313-982-8419
Mailing Address - Fax:313-982-4430
Practice Address - Street 1:HENRY FORD HEALTH SYSTEM
Practice Address - Street 2:19401 HUBBARD DRIVE, SUITE#202
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126
Practice Address - Country:US
Practice Address - Phone:313-982-8419
Practice Address - Fax:313-982-4430
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058379208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262310OtherBLUE CROSS-BLUE CROSS
MI307003610Medicaid
MB058379OtherCHAMPUS-CHAMPUS
MB058379OtherCOMMERCIAL-COMMERCIAL NUMBER
MB058379OtherCOMMERCIAL-COMMERCIAL NUMBER
F85650Medicare UPIN