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General NPI Number Information
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NPI Number | 1700672888
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Entity Type | Individual
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Provider Name | LIKHITH SAI MANDAVA
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Gender | Male
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 10/08/2025
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Provider Practice Location Address
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Address Line | 205 N EAST AVE, HENRY FORD JACKSON HOSPITAL
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City | JACKSON
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State | MI
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Zip | 49201
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Country | US
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Telephone | 517-205-7116
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Fax | 517-205-7050
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Provider Business Mailing Address
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Address Line | 205 N EAST AVE, HENRY FORD JACKSON HOSPITAL
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City | JACKSON
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State | MI
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Zip | 49201
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Country | US
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Telephone | 517-205-7116
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Fax | 517-205-7050
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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 | 4351055066
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License Number State | MI
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Taxonomy #2
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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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