Provider Demographics
NPI:1598737504
Name:MOHTA, PRABHA B (MD)
Entity Type:Individual
Prefix:
First Name:PRABHA
Middle Name:B
Last Name:MOHTA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:35180 NANKIN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-2092
Mailing Address - Country:US
Mailing Address - Phone:734-261-0005
Mailing Address - Fax:734-466-8567
Practice Address - Street 1:35180 NANKIN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-2092
Practice Address - Country:US
Practice Address - Phone:734-261-0005
Practice Address - Fax:734-466-8567
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301050374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1765296Medicaid
08206740011Medicare ID - Type Unspecified
MI1765296Medicaid