Provider Demographics
NPI:1679914881
Name:MADHUMALTI BHAVSAR LLC
Entity type:Organization
Organization Name:MADHUMALTI BHAVSAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADHUMALTI
Authorized Official - Middle Name:D
Authorized Official - Last Name:BHAVSAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-717-1555
Mailing Address - Street 1:317 ECORSE RD
Mailing Address - Street 2:STE 12
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-5787
Mailing Address - Country:US
Mailing Address - Phone:734-717-1555
Mailing Address - Fax:734-398-5056
Practice Address - Street 1:317 ECORSE RD
Practice Address - Street 2:STE 12
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-5787
Practice Address - Country:US
Practice Address - Phone:734-717-1555
Practice Address - Fax:734-398-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010681932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty