Individual
MR. BHASKAR DEVANAGONDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2110 16TH ST 1, BAY PEDIATRIC CLINIC, BAY, MI 48708
(989) 892-2517
(989) 892-4860
Mailing address
2110 16TH ST 1, BAY PEDIATRIC CLINIC, BAY, MI 48708
(989) 892-2517
(989) 892-4860
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
BD049357
MI
208000000X
Pediatrics Physician
Primary
BD049357
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821116
—
MI
01
—
3500941021
HEALTH PLUS
MI
01
—
350Z96028
BLUE CROSS
MI
Enumeration date
12/11/2006
Last updated
08/23/2011
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