Healthcare Provider Details

I. General information

NPI: 1760482871
Provider Name (Legal Business Name): MANISHA PARIKH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47601 GRAND RIVER AVE B233
NOVI MI
48374-1233
US

IV. Provider business mailing address

25925 TELEGRAPH RD 210
SOUTHFIELD MI
48034-2518
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-4809
  • Fax: 248-465-4809
Mailing address:
  • Phone: 248-746-0342
  • Fax: 248-746-0308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301059611
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: