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General NPI Number Information
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NPI Number | 1669588018
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Entity Type | Individual
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Provider Name | AJAY KUMAR BHARGAVA PT
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Gender | Male
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 1601 E MICHIGAN AVE SUITE 103
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City | LANSING
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State | MI
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Zip | 48912-2894
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Country | US
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Telephone | 517-349-4268
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Fax | 517-349-4298
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Provider Business Mailing Address
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Address Line | 3530 E HIAWATHA DR
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City | OKEMOS
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State | MI
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Zip | 48864-4041
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Country | US
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Telephone | 517-372-2700
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Fax | 517-349-4298
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501005343
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License Number State | MI
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