Provider Demographics
NPI:1821122169
Name:RAMESH K MOHINDRA MD PC
Entity Type:Organization
Organization Name:RAMESH K MOHINDRA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOHINDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-779-2123
Mailing Address - Street 1:14555 LEVAN RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5083
Mailing Address - Country:US
Mailing Address - Phone:734-779-2123
Mailing Address - Fax:
Practice Address - Street 1:14555 LEVAN RD
Practice Address - Street 2:SUITE 112
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5083
Practice Address - Country:US
Practice Address - Phone:734-779-2123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033586174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1108238712OtherBCBS OF MI
MI0829730OtherMEDICARE PLUS BLUE
MI0829730OtherMEDICARE PLUS BLUE
MIB43495Medicare UPIN
MI0827930Medicare ID - Type Unspecified