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General NPI Number Information
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NPI Number | 1508170929
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Entity Type | Organization
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Legal Business Name | MANILAL O MEWADA MDPC
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 4001 WALLI STRASSE DR SUITE C
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City | BURTON
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State | MI
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Zip | 48509-1729
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Country | US
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Telephone | 810-743-5400
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Fax | 810-743-5474
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Provider Business Mailing Address
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Address Line | 4001 WALLI STRASSE DR SUITE C
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City | BURTON
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State | MI
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Zip | 48509-1729
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Country | US
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Telephone | 810-743-5400
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Fax | 810-743-5474
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MANILAL O MEWADA
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Credential | MD
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Telephone | 810-743-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MM041950
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License Number State | MI
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