Healthcare Provider Details

I. General information

NPI: 1639121841
Provider Name (Legal Business Name): MANISH N KESLIKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27211 LAHSER ROAD STE #200
SOUTHFIELD MI
48034-4147
US

IV. Provider business mailing address

28411 NORTHWESTERN HWY STE # 1050
SOUTHFIELD MI
48034-0047
US

V. Phone/Fax

Practice location:
  • Phone: 248-358-4892
  • Fax: 248-358-5125
Mailing address:
  • Phone: 248-354-4709
  • Fax: 248-354-4807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMK080609
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301080609
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: