Provider Demographics
NPI:1811235872
Name:DESWAL, MANINDER S (DPM)
Entity Type:Individual
Prefix:DR
First Name:MANINDER
Middle Name:S
Last Name:DESWAL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1500 WATERTOWER PL
Mailing Address - Street 2:STE 300
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8048
Mailing Address - Country:US
Mailing Address - Phone:517-351-7640
Mailing Address - Fax:517-351-9462
Practice Address - Street 1:1500 WATERTOWER PL
Practice Address - Street 2:STE 300
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8048
Practice Address - Country:US
Practice Address - Phone:517-351-7640
Practice Address - Fax:517-351-9462
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-26
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901002470213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist