Provider Demographics
NPI:1427029453
Name:MOHINDRA, AMIT R (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:R
Last Name:MOHINDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14555 LEVAN RD
Mailing Address - Street 2:STE. 112
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5083
Mailing Address - Country:US
Mailing Address - Phone:734-779-2123
Mailing Address - Fax:734-779-2163
Practice Address - Street 1:14555 LEVAN RD
Practice Address - Street 2:STE. 112
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5083
Practice Address - Country:US
Practice Address - Phone:734-779-2123
Practice Address - Fax:734-779-2163
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301074778174400000X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104885126Medicaid
MI1108238712OtherBCBS OF MI
MI0P17890OtherMEDICARE PLUS BLUE
MIP48430002Medicare UPIN
MII31263Medicare UPIN