Provider Demographics
NPI:1780793893
Name:KIA, MANISHA (DO)
Entity type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:
Last Name:KIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MANISHA
Other - Middle Name:
Other - Last Name:NARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8423 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-2487
Mailing Address - Country:US
Mailing Address - Phone:810-579-0466
Mailing Address - Fax:810-679-0470
Practice Address - Street 1:8423 HOLLY RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-2487
Practice Address - Country:US
Practice Address - Phone:810-579-0466
Practice Address - Fax:810-679-0470
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5193572Medicaid
MI4626797Medicaid
MIN72340054Medicare PIN