Healthcare Provider Details

I. General information

NPI: 1215465034
Provider Name (Legal Business Name): RISHI MAHAJAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 TELEGRAPH RD STE 104
TAYLOR MI
48180-3376
US

IV. Provider business mailing address

10501 TELEGRAPH RD STE 104
TAYLOR MI
48180-3376
US

V. Phone/Fax

Practice location:
  • Phone: 734-472-2700
  • Fax: 734-472-2701
Mailing address:
  • Phone: 734-472-2700
  • Fax: 734-472-2701

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 Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002702
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: