Provider Demographics
NPI:1639300692
Name:VANIAWALA, BHAVNA VISHWAS (MD)
Entity Type:Individual
Prefix:
First Name:BHAVNA
Middle Name:VISHWAS
Last Name:VANIAWALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S SAGINAW ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-1803
Mailing Address - Country:US
Mailing Address - Phone:810-762-1444
Mailing Address - Fax:810-762-1448
Practice Address - Street 1:420 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-1803
Practice Address - Country:US
Practice Address - Phone:810-762-1444
Practice Address - Fax:810-762-1448
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301094243208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics