Physician Compare National (NPI:1417136029)

HEALTHCARE PROVIDER: MANISHA MEHTA D.P.M.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1417136029
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9133219389
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20081230000213
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MEHTA
	Individual professional last name
Provider First Name	MANISHA
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	KENT STATE UNIVERSITY COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	2005
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	15 E KIRBY ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 102
	Group Practice or individual's line 2 address
City	DETROIT
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	482024038
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y