Healthcare Provider Details

I. General information

NPI: 1508170929
Provider Name (Legal Business Name): MANILAL O MEWADA MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 07/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 WALLI STRASSE DR SUITE C
BURTON MI
48509-1729
US

IV. Provider business mailing address

4001 WALLI STRASSE DR SUITE C
BURTON MI
48509-1729
US

V. Phone/Fax

Practice location:
  • Phone: 810-743-5400
  • Fax: 810-743-5474
Mailing address:
  • Phone: 810-743-5400
  • Fax: 810-743-5474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMM041950
License Number StateMI

VIII. Authorized Official

Name: DR. MANILAL O MEWADA
Title or Position: PRESIDENT
Credential: MD
Phone: 810-743-5400