Healthcare Provider Details

I. General information

NPI: 1720652662
Provider Name (Legal Business Name): MANOJ UPADHYAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2021
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HURLEY PLAZA GME OFFICE 10W
FLINT MI
48503-5902
US

IV. Provider business mailing address

1541 KINGS HWY
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 810-262-9080
  • Fax: 810-262-9080
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number351808
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: