Provider Demographics
NPI:1639121841
Name:KESLIKER, MANISH N (MD)
Entity Type:Individual
Prefix:
First Name:MANISH
Middle Name:N
Last Name:KESLIKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28411 NORTHWESTERN HWY
Mailing Address - Street 2:STE # 1050
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-0047
Mailing Address - Country:US
Mailing Address - Phone:248-354-4709
Mailing Address - Fax:248-354-4807
Practice Address - Street 1:27211 LAHSER ROAD
Practice Address - Street 2:STE #200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-4147
Practice Address - Country:US
Practice Address - Phone:248-358-4892
Practice Address - Fax:248-358-5125
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMK080609207R00000X
MI4301080609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1346398971OtherCORPORTATE NPI
MI104854219Medicaid
MI11-0F33636-0OtherBCBSM GRP PIN
MI20-5485614OtherTAX ID
MIMK080609OtherSTATE LICENSE
MI1346398971OtherCORPORTATE NPI
MII44291Medicare UPIN
MI0P41360015Medicare PIN