Provider Demographics
NPI:1346242591
Name:ATRI, MANOHAR (MD)
Entity Type:Individual
Prefix:
First Name:MANOHAR
Middle Name:
Last Name:ATRI
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 1:4855 BERL DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-2801
Mailing Address - Country:US
Mailing Address - Phone:989-799-8000
Mailing Address - Fax:989-799-8797
Practice Address - Street 1:4855 BERL DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2801
Practice Address - Country:US
Practice Address - Phone:989-799-8000
Practice Address - Fax:989-799-8797
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2007-07-09
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-05-17
Provider Licenses
StateLicense IDTaxonomies
MI486605207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1107309722OtherBLUE CROSS BLUE SHIELD
MIC3336OtherMCARE
MIE82654OtherPALMETTO GBA
MI1078667OtherCIGNA
MI1001269OtherMCCLAREN HEALTH PLAN
MI3127406Medicaid
MI31814OtherPRIORITY HEALTH
MI383225867991OtherCOMMUNITY CHOICE
MI4219281OtherAETNA
MI383225867OtherHUMANA
MI383225867OtherTRICARE
MIP64820OtherBLUE CARE NETWORK
MI1107309721OtherSAGINAW HEALTH PLAN
MI3127406OtherMOLINA
MIHUMANA CHOICEOther383225867
MI1107309721OtherHEALTH PLUS
MI118391OtherGREAT LAKES HEALTH PLAN
MI383225867OtherTRICARE FOR LIFE NORTH
MI1107309721OtherHEALTH PLUS
MIE82654Medicare UPIN