Provider Demographics
NPI:1457333718
Name:BHOGAONKER, ANANT B (MD)
Entity Type:Individual
Prefix:DR
First Name:ANANT
Middle Name:B
Last Name:BHOGAONKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:22255 GREENFIELD RD
Mailing Address - Street 2:STE 320
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3710
Mailing Address - Country:US
Mailing Address - Phone:248-559-7958
Mailing Address - Fax:248-559-9080
Practice Address - Street 1:22255 GREENFIELD RD
Practice Address - Street 2:STE 320
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3710
Practice Address - Country:US
Practice Address - Phone:248-559-7958
Practice Address - Fax:248-559-9080
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301031977208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2114332Medicaid
06332159351Medicare ID - Type Unspecified
MI2114332Medicaid