Provider Demographics
NPI:1649278516
Name:BHAN, RAAKESH C (MD)
Entity type:Individual
Prefix:
First Name:RAAKESH
Middle Name:C
Last Name:BHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 CAPITAL AVE SW STE 205
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-9393
Mailing Address - Country:US
Mailing Address - Phone:269-441-1000
Mailing Address - Fax:269-441-1002
Practice Address - Street 1:3600 CAPITAL AVE SW STE 205
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9393
Practice Address - Country:US
Practice Address - Phone:269-441-1000
Practice Address - Fax:269-441-1002
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301048458207RC0200X
MIRB048458207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2792609Medicaid
MIOM76510002Medicare ID - Type Unspecified
MIA76272Medicare UPIN
MIMI1609071Medicare PIN