Healthcare Provider Details

I. General information

NPI: 1790639557
Provider Name (Legal Business Name): BHARATH YALAVARTHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MICHIGAN ST NE
GRAND RAPIDS MI
49503-2508
US

IV. Provider business mailing address

5330 FALKIRK CT
SUPERIOR TOWNSHIP MI
48198-9652
US

V. Phone/Fax

Practice location:
  • Phone: 616-233-1678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: