Individual
MANILAL O MEWADA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4001 WALLI STRASSE, SUITE C, BURTON, MI 48509-1729
(810) 743-5400
(810) 743-5474
Mailing address
4001 WALLI STRASSE, SUITE C, BURTON, MI 48509-1729
(810) 743-5400
(810) 743-5474
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301041950
MI
207V00000X
Obstetrics & Gynecology Physician
Primary
MM041950
MI
208D00000X
General Practice Physician
4301041950
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1566962
—
MI
01
—
1602508232
BLUE CROSS BLUE SHIELD
MI
Enumeration date
10/03/2006
Last updated
02/22/2021
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