Individual
MANISHA MEHTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
4160 JOHN R ST STE 1011, DETROIT, MI 48201-2017
(313) 833-3090
(313) 833-7843
Mailing address
4160 JOHN R ST STE 1011, DETROIT, MI 48201-2017
(313) 833-3090
(313) 833-7843
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
36. 003467
OH
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
5901002275
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316191679
—
MI
05
—
1417136029
—
MI
01
—
1891939682
DME SUPPLIER NUMBER
MI
Enumeration date
10/31/2007
Last updated
08/11/2023
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