Provider Demographics
NPI:1881483592
Name:MAHAWA, RUKAM
Entity type:Individual
Prefix:
First Name:RUKAM
Middle Name:
Last Name:MAHAWA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HNO, 408 TILAK NAGAR, AMIRITSAR
Mailing Address - Street 2:PIN:143001, PUNJAB, INDIA
Mailing Address - City:AMRITSAR
Mailing Address - State:PUNJAB
Mailing Address - Zip Code:143001
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37595 SEVEN MILE RD, TRINITY HEALTH ACADEMIC INTERNAL M
Practice Address - Street 2:SUITE 340, LIVONIA, MICHIGAN 48152
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-793-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program