Provider Demographics
NPI:1144215492
Name:MUKHI, PARMOD KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:PARMOD
Middle Name:KUMAR
Last Name:MUKHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46275 WHITE PINES DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-4309
Mailing Address - Country:US
Mailing Address - Phone:248-763-0501
Mailing Address - Fax:248-692-5115
Practice Address - Street 1:14585 NORTHLINE RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2469
Practice Address - Country:US
Practice Address - Phone:248-763-0501
Practice Address - Fax:248-692-5115
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0083518208100000X
MIPM059604208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4344396Medicaid
MI4344396Medicaid
MI0P30630729Medicare PIN
MION34810Medicare ID - Type Unspecified