Healthcare Provider Details

I. General information

NPI: 1356792121
Provider Name (Legal Business Name): NEESHA BHAVESH PATEL-PETERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NEESHA BHAVESH PATEL MD

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 CHALLIS RD
BRIGHTON MI
48116-7446
US

IV. Provider business mailing address

3621 S STATE ST
ANN ARBOR MI
48108-1633
US

V. Phone/Fax

Practice location:
  • Phone: 810-227-9510
  • Fax:
Mailing address:
  • Phone: 734-647-5299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301118971
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: