Provider Demographics
NPI:1689869513
Name:MOHINDRA, MISHA (MD)
Entity Type:Individual
Prefix:
First Name:MISHA
Middle Name:
Last Name:MOHINDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 OAK ST SE STE 5070
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3998
Mailing Address - Country:US
Mailing Address - Phone:503-561-8565
Mailing Address - Fax:503-561-8560
Practice Address - Street 1:875 OAK ST SE STE 5070
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3998
Practice Address - Country:US
Practice Address - Phone:503-561-8565
Practice Address - Fax:503-561-8560
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999136261207R00000X
IL036 116256207R00000X
ORMD28056207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH13705Medicare UPIN