Basic Information
| Provider Information | |||||||||
| NPI: | 1538343736 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMIT R. MOHINDRA, MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14555 LEVAN ROAD | ||||||||
| Address2: | SUITE112 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481545085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347792123 | ||||||||
| FaxNumber: | 7747792163 | ||||||||
| Practice Location | |||||||||
| Address1: | 14555 LEVAN ROAD | ||||||||
| Address2: | SUITE112 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481545085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347792123 | ||||||||
| FaxNumber: | 7747792163 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2007 | ||||||||
| LastUpdateDate: | 12/24/2007 | ||||||||
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| AuthorizedOfficialLastName: | NADAI | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2485473914 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | AM074778 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1108238712 | 01 | MI | BCBSM | OTHER |