MEDICARE: DR. JAY PRADHAN M.D.

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	207RC0000X	Cardiovascular Disease Physician	JP071846	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0P01030	OTHER	MI	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1108297492	OTHER	MI	BCBS NUMBERS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790755049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY PRADHAN M.D.

Provider Business Mailing Address
First Line	:	75 BARCLAY CIR
Second Line	:	SUITE 230
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5820
Country	:	US
Telephone Number	:	248-246-1127
Fax Number	:	248-246-0704

Provider Business Practice Location Address
First Line	:	75 BARCLAY CIR
Second Line	:	SUITE 230
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5820
Country	:	US
Telephone Number	:	248-246-1127
Fax Number	:	248-246-0704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	06/04/2026

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Directions to “ DR. JAY PRADHAN M.D.” Practice Location

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