Provider Demographics
NPI:1750379913
Name:PATEL, BHAVIN PRAVIN (MD)
Entity type:Individual
Prefix:DR
First Name:BHAVIN
Middle Name:PRAVIN
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 W AVON RD
Mailing Address - Street 2:STE 2
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2761
Mailing Address - Country:US
Mailing Address - Phone:248-651-1133
Mailing Address - Fax:248-651-5004
Practice Address - Street 1:950 W AVON RD
Practice Address - Street 2:SUITE #A-5
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2761
Practice Address - Country:US
Practice Address - Phone:248-651-1133
Practice Address - Fax:248-651-5004
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068679207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4624353Medicaid
MI4301068679OtherSTATE MEDICAL LIC
MI0N29890Medicare ID - Type Unspecified
MI4301068679OtherSTATE MEDICAL LIC