Healthcare Provider Details

I. General information

NPI: 1427058734
Provider Name (Legal Business Name): MANHAR J TEJURA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N MACOMB ST STE 429
MONROE MI
48162-2900
US

IV. Provider business mailing address

730 N MACOMB ST STE 429
MONROE MI
48162-2900
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-7060
  • Fax: 734-241-7580
Mailing address:
  • Phone: 734-242-7060
  • Fax: 734-241-7580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMT037750
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35043289T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: