Provider Demographics
NPI:1730132077
Name:TOBIA, MANHAL WADIE (MD)
Entity Type:Individual
Prefix:MR
First Name:MANHAL
Middle Name:WADIE
Last Name:TOBIA
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 1:18161 W 12 MILE RD
Mailing Address - Street 2:STE 2
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076
Mailing Address - Country:US
Mailing Address - Phone:248-552-1200
Mailing Address - Fax:248-552-1201
Practice Address - Street 1:18161 W 12 MILE RD
Practice Address - Street 2:STE 2
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076
Practice Address - Country:US
Practice Address - Phone:248-552-1200
Practice Address - Fax:248-552-1201
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMT68505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4416833Medicaid
MION52710Medicare ID - Type Unspecified
MI4416833Medicaid