Provider Demographics
NPI:1790474021
Name:BAIRAGEE, AMITA
Entity Type:Individual
Prefix:
First Name:AMITA
Middle Name:
Last Name:BAIRAGEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8904 GEORGE AVE
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1406
Mailing Address - Country:US
Mailing Address - Phone:269-473-3842
Mailing Address - Fax:
Practice Address - Street 1:8904 GEORGE AVE
Practice Address - Street 2:
Practice Address - City:BERRIEN SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49103-1406
Practice Address - Country:US
Practice Address - Phone:269-473-3842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI110338343311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home