Healthcare Provider Details

I. General information

NPI: 1245286509
Provider Name (Legal Business Name): GAITI ARA BAKHSH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 TELEGRAPH ROAD, EMERGENCY MEDICINE DEPARTMENT
TAYLOR MI
48180-3330
US

IV. Provider business mailing address

38935 ANN ARBOR ROAD CREDENTIALING/PAYER CONTRACTING SERVICES
LIVONIA MI
48150-3397
US

V. Phone/Fax

Practice location:
  • Phone: 313-295-5007
  • Fax: 313-295-6725
Mailing address:
  • Phone: 734-632-0175
  • Fax: 734-632-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101011604
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102203148
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS016514
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: