Basic Information
| Provider Information | |||||||||
| NPI: | 1639121841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KESLIKER | ||||||||
| FirstName: | MANISH | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28411 NORTHWESTERN HWY | ||||||||
| Address2: | STE # 1050 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480340047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483544709 | ||||||||
| FaxNumber: | 2483544807 | ||||||||
| Practice Location | |||||||||
| Address1: | 27211 LAHSER ROAD | ||||||||
| Address2: | STE #200 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480344147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483584892 | ||||||||
| FaxNumber: | 2483585125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 02/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MK080609 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4301080609 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1346398971 | 01 | MI | CORPORTATE NPI | OTHER | 104854219 | 05 | MI | MEDICAID | 11-0F33636-0 | 01 | MI | BCBSM GRP PIN | OTHER | 20-5485614 | 01 | MI | TAX ID | OTHER | MK080609 | 01 | MI | STATE LICENSE | OTHER |