Basic Information
| Provider Information | |||||||||
| NPI: | 1528212768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHATTACHARYA | ||||||||
| FirstName: | PRATIK | ||||||||
| MiddleName: | DIPAKESHWAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44428 WOODWARD AVE | ||||||||
| Address2: | SUITE 101-CREDENTIALING | ||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483415009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488586144 | ||||||||
| FaxNumber: | 2488586232 | ||||||||
| Practice Location | |||||||||
| Address1: | 44555 WOODWARD AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | PONTIAC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483415031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488586104 | ||||||||
| FaxNumber: | 2488586115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2008 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084V0102X | 4301088454 | MI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology | 2084N0400X | 4301088454 | MI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.