Provider Demographics
NPI:1508170929
Name:MANILAL O MEWADA MDPC
Entity Type:Organization
Organization Name:MANILAL O MEWADA MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANILAL
Authorized Official - Middle Name:O
Authorized Official - Last Name:MEWADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-743-5400
Mailing Address - Street 1:4001 WALLI STRASSE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1729
Mailing Address - Country:US
Mailing Address - Phone:810-743-5400
Mailing Address - Fax:810-743-5474
Practice Address - Street 1:4001 WALLI STRASSE DR
Practice Address - Street 2:SUITE C
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1729
Practice Address - Country:US
Practice Address - Phone:810-743-5400
Practice Address - Fax:810-743-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMM041950207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1566962Medicaid
MI1566962Medicaid