MEDICARE: DR. PRERANA ANAND MANOHAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	4301080691	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265423651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRERANA ANAND MANOHAR M.D.

Provider Business Mailing Address
First Line	:	5043 CASCADE RD SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3724
Country	:	US
Telephone Number	:	616-719-5939
Fax Number	:	616-719-5933

Provider Business Practice Location Address
First Line	:	5043 CASCADE RD SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-3724
Country	:	US
Telephone Number	:	616-719-5939
Fax Number	:	616-719-5933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	03/05/2010

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