Healthcare Provider Details

I. General information

NPI: 1093948200
Provider Name (Legal Business Name): ABHISHEK MEWADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST UHC 5C
DETROIT MI
48201-2153
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST UHC 5C
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-4342
  • Fax: 313-745-4707
Mailing address:
  • Phone: 313-577-4342
  • Fax: 313-745-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5315041737
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5315041737
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: