Provider Demographics
NPI:1700820693
Name:LATHIA, MUKESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:
Last Name:LATHIA
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 1:690 S TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-7692
Mailing Address - Country:US
Mailing Address - Phone:989-922-4900
Mailing Address - Fax:989-922-4911
Practice Address - Street 1:690 S TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-7692
Practice Address - Country:US
Practice Address - Phone:989-922-4900
Practice Address - Fax:989-922-4911
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010730762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4318073Medicaid
MI90097OtherBCBS
5888666OtherAETNA
MIN3404800001OtherMEDICARE
MI0982788OtherHEALTH PLUS
MI260Z910350OtherBCBS
MIN3404800001OtherMEDICARE