Healthcare Provider Details

I. General information

NPI: 1194891663
Provider Name (Legal Business Name): ARUNA BAVINENI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30901 PALMER RD
WESTLAND MI
48186-9529
US

IV. Provider business mailing address

3425 CHEROKEE TRL
YPSILANTI MI
48198-9498
US

V. Phone/Fax

Practice location:
  • Phone: 734-367-8520
  • Fax:
Mailing address:
  • Phone: 734-645-3543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301059562
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: