MEDICARE: MR. MAYUR SRINIVAS PATHAN 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1528995750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAYUR SRINIVAS PATHAN M.D.

Provider Business Mailing Address
First Line	:	6071 W OUTER DR., SINAI-GRACE HOSPITAL
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235
Country	:	US
Telephone Number	:	313-966-7434
Fax Number	:	313-966-1738

Provider Business Practice Location Address
First Line	:	6071 W OUTER DR., SINAI-GRACE HOSPITAL
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235
Country	:	US
Telephone Number	:	313-966-7434
Fax Number	:	313-966-1738

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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