Individual
JACOB ROSHANMANESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
620 W EDISON RD STE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
Mailing address
620 W EDISON RD STE 110, MISHAWAKA, IN 46545-2784
(574) 258-1100
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01081681A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2014
Last updated
03/22/2021
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