Provider Demographics
NPI:1205011319
Name:GYNECOLOGY AND HOLISTIC CARE PC
Entity Type:Organization
Organization Name:GYNECOLOGY AND HOLISTIC CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:BHAVNAGRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-228-7075
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJB040663207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4649503Medicaid
MIJB040663OtherLICENSE
MI=========OtherTAX ID
MID73101Medicare UPIN