Provider Demographics
NPI:1972764520
Name:BAKSHI, SRIJANA PRADHAN (MD)
Entity Type:Individual
Prefix:
First Name:SRIJANA
Middle Name:PRADHAN
Last Name:BAKSHI
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 1:1669 HAMILTON RD STE 220
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1960
Mailing Address - Country:US
Mailing Address - Phone:248-686-8426
Mailing Address - Fax:517-483-2350
Practice Address - Street 1:1669 HAMILTON RD STE 220
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1960
Practice Address - Country:US
Practice Address - Phone:517-993-6366
Practice Address - Fax:517-483-2350
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2023-04-13
Deactivation Date:2020-03-11
Deactivation Code:
Reactivation Date:2020-03-25
Provider Licenses
StateLicense IDTaxonomies
PAMT191954207R00000X
MI4301102450207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine