MEDICARE: DR. ARSALA BAKHTYAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0208X	Pediatric Infectious Diseases Physician	4301089589	MI
2	208000000X	Pediatrics Physician	4301089589	MI

General Provider Information

NPI Number	:	1164623823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARSALA BAKHTYAR M.D.

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:	947-522-1863
Fax Number	:	947-522-0307

Provider Business Practice Location Address
First Line	:	18181 OAKWOOD BLVD STE 401
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-5031
Country	:	US
Telephone Number	:	313-593-7240
Fax Number	:	313-593-8899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/18/2023

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