Provider Demographics
NPI:1700044864
Name:INDIRA C. MISRA HIGGINS, DO PLLC
Entity Type:Organization
Organization Name:INDIRA C. MISRA HIGGINS, DO PLLC
Other - Org Name:INDIRA C. MISRA HIGGINS, DO PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INDIRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MISRA HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:248-723-5802
Mailing Address - Street 1:31815 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5471
Mailing Address - Country:US
Mailing Address - Phone:248-723-5802
Mailing Address - Fax:
Practice Address - Street 1:31815 SOUTHFIELD RD
Practice Address - Street 2:SUITE 18
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5471
Practice Address - Country:US
Practice Address - Phone:248-723-5802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012883207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty