Individual
LIKHITH SAI MANDAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
205 N EAST AVE, HENRY FORD JACKSON HOSPITAL, JACKSON, MI 49201
(517) 205-7116
(517) 205-7050
Mailing address
205 N EAST AVE, HENRY FORD JACKSON HOSPITAL, JACKSON, MI 49201
(517) 205-7116
(517) 205-7050
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
4351055066
MI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/16/2025
Last updated
10/08/2025
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