Organization
PONNIAH MOHAN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PONNIAH MOHAN MD (PHYSICIAN)
(586) 574-2020
Entity
Organization
Contact information
Practice address
11446 E 13 MILE RD, SUITE B, WARREN, MI 48093-6571
(586) 574-2020
(586) 574-2919
Mailing address
11446 E 13 MILE RD, SUITE B, WARREN, MI 48093-6571
(586) 574-2020
(586) 574-2919
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
PM039179
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1682676
—
MI
01
—
3505021342
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
04/29/2008
Last updated
05/06/2008
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