Healthcare Provider Details

I. General information

NPI: 1588907299
Provider Name (Legal Business Name): MANAL PERACHA-RIYAZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N MONROE ST
MONROE MI
48162-2936
US

IV. Provider business mailing address

725 N MONROE ST
MONROE MI
48162-2936
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-2727
  • Fax: 734-242-2745
Mailing address:
  • Phone: 734-242-2727
  • Fax: 734-242-2745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0086473
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD046531
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301103242
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: