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General NPI Number Information
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NPI Number | 1992899546
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Entity Type | Individual
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Provider Name | MANILAL O MEWADA M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 02/22/2021
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Provider Practice Location Address
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Address Line | 4001 WALLI STRASSE 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 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 |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301041950
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301041950
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License Number State | MI
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Taxonomy #3
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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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