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1700820693

NPI Code Detail

MEDICARE: DR. MUKESH LATHIA MD

MEDICARE: DR. MUKESH LATHIA MD

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	2084P0800X	Psychiatry Physician	4301073076	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	N3404800001	OTHER	MI	MEDICARE

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
2	90097	OTHER	MI	BCBS
3	5888666	OTHER		AETNA
5	0982788	OTHER	MI	HEALTH PLUS
6	260Z910350	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1700820693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUKESH LATHIA MD

Provider Business Mailing Address
First Line	:	690 S TRUMBULL ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7692
Country	:	US
Telephone Number	:	989-922-4900
Fax Number	:	989-922-4911

Provider Business Practice Location Address
First Line	:	690 S TRUMBULL ST
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48708-7692
Country	:	US
Telephone Number	:	989-922-4900
Fax Number	:	989-922-4911

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	04/12/2021

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690 S TRUMBULL ST
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1952598948 — MS. STEPHANIE SUE STEVENSON
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1619159555 — HOLLY ELIZABETH HARRISON LMSW
Practice Location Address:

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BAY CITY, MI
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1952555856 — DR. CRAIG RODNEY FORD DMIN, MA
Practice Location Address:

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48708-7692

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1942449830 — LETICIA SLATES
Practice Location Address:

690 S TRUMBULL ST
BAY CITY, MI
48708-7692

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Directions to “ DR. MUKESH LATHIA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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