Individual
MANOJ MITHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
715 S HEALTH PKWY, THREE RIVERS, MI 49093-8352
(269) 273-8471
(269) 273-9680
Mailing address
701 S HEALTH PKWY, MEDICAL STAFF OFFICE, THREE RIVERS, MI 49093-8352
(269) 273-9789
(269) 273-9611
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301088958
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336260645
—
MI
01
—
2507510592
BCBS PIN
—
01
—
382317300011
TRICARE
—
01
—
46525
HEALTH PLAN OF MICHIGAN
MI
01
—
700G560080
BCBS GROUP-THREE RIVERS HEALTH
MI
Enumeration date
04/03/2007
Last updated
10/30/2008
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