Healthcare Provider Details

I. General information

NPI: 1427430677
Provider Name (Legal Business Name): BHAVANA VYAS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43475 DALCOMA DR STE 208
CLINTON TWP MI
48038-3593
US

IV. Provider business mailing address

43475 DALCOMA DR STE 208
CLINTON TWP MI
48038-3593
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-1818
  • Fax: 586-314-6044
Mailing address:
  • Phone: 586-263-1818
  • Fax: 586-314-6044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BHAVANA VYAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 586-263-1818