Provider Demographics
NPI:1275586091
Name:A M MANOHAR MD PC
Entity Type:Organization
Organization Name:A M MANOHAR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:MUKUND
Authorized Official - Last Name:MANOHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-278-7122
Mailing Address - Street 1:87 W PEARL ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1933
Mailing Address - Country:US
Mailing Address - Phone:517-278-7122
Mailing Address - Fax:517-279-4974
Practice Address - Street 1:87 W PEARL ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1933
Practice Address - Country:US
Practice Address - Phone:517-278-7122
Practice Address - Fax:517-279-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033478207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1398393Medicaid
MI1398393Medicaid
0P52630Medicare PIN
0260650001Medicare NSC