Provider Demographics
NPI:1972761583
Name:MOHAN DASS MACHA MD PC
Entity Type:Organization
Organization Name:MOHAN DASS MACHA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:DASS
Authorized Official - Last Name:MACHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-635-7131
Mailing Address - Street 1:6417 MARLETTE ST
Mailing Address - Street 2:
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1305
Mailing Address - Country:US
Mailing Address - Phone:989-635-7131
Mailing Address - Fax:989-635-6303
Practice Address - Street 1:6417 MARLETTE ST
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1305
Practice Address - Country:US
Practice Address - Phone:989-635-7131
Practice Address - Fax:989-635-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071001207RE0101X
MI4301032660208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty