Provider Demographics
NPI:1295852895
Name:MOHAN, MONIKA (MD)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 COLLINS RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-5894
Mailing Address - Country:US
Mailing Address - Phone:517-908-3600
Mailing Address - Fax:517-908-3601
Practice Address - Street 1:4202 COLLINS RD
Practice Address - Street 2:SUITE 115
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-5894
Practice Address - Country:US
Practice Address - Phone:517-908-3600
Practice Address - Fax:517-908-3601
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085456207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5200480Medicaid
MI200000012628OtherPHYSICIANS HEALTH PLAN
MIMI4440001Medicare PIN
MIP41320005Medicare PIN