Individual
DR. MITHILESH J MISHRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 MICHIGAN ST NE, GRAND RAPIDS, MI 49503-2032
(616) 454-5278
(616) 454-4030
Mailing address
1400 MICHIGAN ST SE STE 2S, GRAND RAPIDS, MI 49503
(616) 454-5278
(616) 454-4030
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
MM043037
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1540509
—
MI
Enumeration date
10/21/2005
Last updated
10/25/2011
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