Healthcare Provider Details

I. General information

NPI: 1326575416
Provider Name (Legal Business Name): ANKIT KUMAR BHATIA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date: 12/21/2017
Reactivation Date: 01/04/2018

III. Provider practice location address

205 N EAST AVE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

PO BOX 670884
DETROIT MI
48267-0884
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-7836
  • Fax: 517-205-7660
Mailing address:
  • Phone: 800-436-7936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number02006641A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5101029645
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number5101029645
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: