Provider Demographics
NPI:1770713554
Name:BHALERAO, ANJALI RAJEEV (OTR)
Entity type:Individual
Prefix:MRS
First Name:ANJALI
Middle Name:RAJEEV
Last Name:BHALERAO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CRESTFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-4782
Mailing Address - Country:US
Mailing Address - Phone:248-740-1314
Mailing Address - Fax:248-740-1314
Practice Address - Street 1:30 CRESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-4782
Practice Address - Country:US
Practice Address - Phone:248-740-1314
Practice Address - Fax:248-740-1314
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201002493172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker