Provider Demographics
NPI:1225204399
Name:DEVINDERJIT S BHANGU, MD PLLC
Entity Type:Organization
Organization Name:DEVINDERJIT S BHANGU, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVINDERJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHANGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-606-7152
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-0835
Mailing Address - Country:US
Mailing Address - Phone:248-346-3062
Mailing Address - Fax:810-606-7155
Practice Address - Street 1:3605 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8070
Practice Address - Country:US
Practice Address - Phone:810-606-7152
Practice Address - Fax:810-606-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071280261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0983359OtherHEALTH PLUS OF MICHIGAN
MI0250410OtherBLUE CARE NETWORK OF MICHIGAN
MI0250410OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI3498834Medicaid
MIF48958Medicare UPIN
MI0M71650Medicare PIN