MEDICARE: BHADRESH NAYAK MD PLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	4301058004	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110500378	OTHER	MI	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770659443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BHADRESH NAYAK MD PLC

Provider Business Mailing Address
First Line	:	8202 IRVING RD
Second Line	:	SUITE 100
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-4614
Country	:	US
Telephone Number	:	586-268-3009
Fax Number	:	586-268-0058

Provider Business Practice Location Address
First Line	:	8202 IRVING RD
Second Line	:	SUITE 100
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48312-4614
Country	:	US
Telephone Number	:	586-268-3009
Fax Number	:	586-268-0058

Authorized Official
Title or Position	:	OWNER AND PHYSICIAN
Name	:	DR. BHADRESH D NAYAK
Credential	:	MD
Telephone Number	:	586-268-3009

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	06/20/2008

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