Healthcare Provider Details

I. General information

NPI: 1720729536
Provider Name (Legal Business Name): MONICA H DHOLAKIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 NAPIER AVE
SAINT JOSEPH MI
49085-2112
US

IV. Provider business mailing address

1234 NAPIER AVE
SAINT JOSEPH MI
49085-2112
US

V. Phone/Fax

Practice location:
  • Phone: 269-982-4941
  • Fax:
Mailing address:
  • Phone: 269-985-4461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301512367
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: