Provider Demographics
NPI:1619034055
Name:THAPA, MEENA K (M D,)
Entity Type:Individual
Prefix:
First Name:MEENA
Middle Name:K
Last Name:THAPA
Suffix:
Gender:F
Credentials:M D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4777 E OUTER DR
Mailing Address - Street 2:DEPT, OF EMERGENCY MED., SJDRH
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3241
Mailing Address - Country:US
Mailing Address - Phone:313-369-5689
Mailing Address - Fax:313-369-5688
Practice Address - Street 1:4777 E OUTER DR
Practice Address - Street 2:DEPT, OF EMERGENCY MED., SJDRH
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3241
Practice Address - Country:US
Practice Address - Phone:313-369-5689
Practice Address - Fax:313-369-5688
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039216207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH26348036Medicare ID - Type Unspecified
F 1013Medicare UPIN