Healthcare Provider Details

I. General information

NPI: 1346242591
Provider Name (Legal Business Name): MANOHAR ATRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 05/17/2006

III. Provider practice location address

4855 BERL DR
SAGINAW MI
48604-2801
US

IV. Provider business mailing address

4855 BERL DR
SAGINAW MI
48604-2801
US

V. Phone/Fax

Practice location:
  • Phone: 989-799-8000
  • Fax: 989-799-8797
Mailing address:
  • Phone: 989-799-8000
  • Fax: 989-799-8797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number486605
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: