Provider Demographics
NPI:1780655225
Name:GANATRA, BALVANT KURJI (MD)
Entity Type:Individual
Prefix:MR
First Name:BALVANT
Middle Name:KURJI
Last Name:GANATRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:G5154 MILLER RD
Mailing Address - Street 2:STE A B
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507
Mailing Address - Country:US
Mailing Address - Phone:810-733-3570
Mailing Address - Fax:810-733-0856
Practice Address - Street 1:G5154 MILLER RD
Practice Address - Street 2:STE A B
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-733-3570
Practice Address - Fax:810-733-0856
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBG040280207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1421393Medicaid
0250077Medicare ID - Type Unspecified
MI1421393Medicaid