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General NPI Number Information
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NPI Number | 1497921621
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Entity Type | Individual
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Provider Name | SHALBHADRA BAFNA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 27423 VAN DYKE AVE
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City | WARREN
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State | MI
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Zip | 48093-2867
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Country | US
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Telephone | 347-207-6757
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Fax |
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Provider Business Mailing Address
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Address Line | 27423 VANDYKE AVE
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City | WARREN
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State | MI
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Zip | 48093-4455
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Country | US
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Telephone | 347-207-6757
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301035967
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License Number State | MI
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