Provider Demographics
NPI:1346738002
Name:KANWAR, MAMTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAMTA
Middle Name:
Last Name:KANWAR
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 1:30150 TELEGRAPH RD STE 271
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4521
Mailing Address - Country:US
Mailing Address - Phone:248-395-5166
Mailing Address - Fax:
Practice Address - Street 1:33400 6 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3165
Practice Address - Country:US
Practice Address - Phone:734-421-2020
Practice Address - Fax:734-421-2290
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301508884207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology