Provider Demographics
NPI:1245286509
Name:BAKHSH, GAITI ARA (DO)
Entity type:Individual
Prefix:
First Name:GAITI
Middle Name:ARA
Last Name:BAKHSH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:38935 ANN ARBOR ROAD
Mailing Address - Street 2:CREDENTIALING/PAYER CONTRACTING SERVICES
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:734-632-0182
Practice Address - Street 1:10000 TELEGRAPH ROAD,
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3330
Practice Address - Country:US
Practice Address - Phone:313-295-5007
Practice Address - Fax:313-295-6725
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011604207P00000X
VA0102203148207P00000X
PAOS016514207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11271278OtherCAQH