Provider Demographics
NPI:1770659443
Name:BHADRESH NAYAK MD PLC
Entity Type:Organization
Organization Name:BHADRESH NAYAK MD PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BHADRESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:NAYAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-268-3009
Mailing Address - Street 1:8202 IRVING RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-4614
Mailing Address - Country:US
Mailing Address - Phone:586-268-3009
Mailing Address - Fax:586-268-0058
Practice Address - Street 1:8202 IRVING RD
Practice Address - Street 2:SUITE 100
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-4614
Practice Address - Country:US
Practice Address - Phone:586-268-3009
Practice Address - Fax:586-268-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI110500378OtherBLUE CROSS BLUE SHIELD
MI4122155Medicaid
MI0P38950Medicare PIN
MI4122155Medicaid