Provider Demographics
NPI:1821295213
Name:MOHAN, MANOJ (DO)
Entity Type:Individual
Prefix:DR
First Name:MANOJ
Middle Name:
Last Name:MOHAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3955 OKEMOS RD
Mailing Address - Street 2:STE A1
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-4208
Mailing Address - Country:US
Mailing Address - Phone:517-349-0027
Mailing Address - Fax:
Practice Address - Street 1:3955 OKEMOS RD
Practice Address - Street 2:STE A1
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-4208
Practice Address - Country:US
Practice Address - Phone:517-349-0027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMM018049207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002434OtherRESIDENT- FELLOW
MI5101018049OtherSTATE OF MICHIGAN LICENSE