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General NPI Number Information
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NPI Number | 1578250056
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Entity Type | Individual
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Provider Name | DR. SUSHMITA MANTRAVADI
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Gender | Female
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 6245 INKSTER RD
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City | GARDEN CITY
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State | MI
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Zip | 48135-4001
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Country | US
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Telephone | 734-458-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 6811 191ST PL NE
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City | REDMOND
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State | WA
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Zip | 98052-0569
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Country | US
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Telephone | 425-553-9749
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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