Provider Demographics
NPI:1528212768
Name:BHATTACHARYA, PRATIK DIPAKESHWAR (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:PRATIK
Middle Name:DIPAKESHWAR
Last Name:BHATTACHARYA
Suffix:
Gender:M
Credentials:MD MPH
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Other - Credentials:
Mailing Address - Street 1:44428 WOODWARD AVE
Mailing Address - Street 2:SUITE 101-CREDENTIALING
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5009
Mailing Address - Country:US
Mailing Address - Phone:248-858-6144
Mailing Address - Fax:248-858-6232
Practice Address - Street 1:44555 WOODWARD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-858-6104
Practice Address - Fax:248-858-6115
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2021-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010884542084V0102X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M02170Medicare PIN