Healthcare Provider Details

I. General information

NPI: 1174104541
Provider Name (Legal Business Name): BHAVYA KUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44405 WOODWARD AVE
PONTIAC MI
48341-5023
US

IV. Provider business mailing address

33333 W 12 MILE RD STE A
FARMINGTON HILLS MI
48334-3312
US

V. Phone/Fax

Practice location:
  • Phone: 248-758-7000
  • Fax:
Mailing address:
  • Phone: 248-536-2127
  • Fax: 248-893-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301517725
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: