Provider Demographics
NPI:1568679785
Name:R BAYATI MD PC
Entity Type:Organization
Organization Name:R BAYATI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-626-4838
Mailing Address - Street 1:5120 WARD LN
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2842
Mailing Address - Country:US
Mailing Address - Phone:916-626-4838
Mailing Address - Fax:916-626-4837
Practice Address - Street 1:5120 WARD LN
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2842
Practice Address - Country:US
Practice Address - Phone:916-626-4838
Practice Address - Fax:916-626-4837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066754261Q00000X
CAC52426261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4721670Medicaid
MIG63608Medicare UPIN
MI0N93130Medicare ID - Type Unspecified