MEDICARE: MR. NIKHIL MEHROTRA MBA

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	251J00000X	Nursing Care Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1700343878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NIKHIL MEHROTRA MBA

Provider Business Mailing Address
First Line	:	36528 GRAND RIVER AVE STE A-3
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-3016
Country	:	US
Telephone Number	:	248-640-9305
Fax Number	:	248-987-6866

Provider Business Practice Location Address
First Line	:	36528 GRAND RIVER AVE STE A-3
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-3016
Country	:	US
Telephone Number	:	248-640-9305
Fax Number	:

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

Provider Enumeration Date	:	02/26/2019
Last Update Date	:	10/05/2020

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