Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 36. 003467 | OH |
N | 222Z00000X | Podiatrist | 36. 003467 | OH |
Y | 213EP1101X | Primary Podiatric Medicine | 5901002275 | MI |
NPI | 1417136029 |
---|---|
Provider Name | Manisha Mehta |
First Address | Detroit, MI 48202-4047 |
Second Address | Detroit, MI 48202-4047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2007 |
Last Update Date | 03/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1316191679 | (05) | MI |
1417136029 | (05) | MI |
1891939682 | DME SUPPLIER NUMBER (01) | MI |