Basic Information
| Provider Information | |||||||||
| NPI: | 1730132077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOBIA | ||||||||
| FirstName: | MANHAL | ||||||||
| MiddleName: | WADIE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18161 W 12 MILE RD | ||||||||
| Address2: | STE 2 | ||||||||
| City: | LATHRUP VILLAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485521200 | ||||||||
| FaxNumber: | 2485521201 | ||||||||
| Practice Location | |||||||||
| Address1: | 18161 W 12 MILE RD | ||||||||
| Address2: | STE 2 | ||||||||
| City: | LATHRUP VILLAGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485521200 | ||||||||
| FaxNumber: | 2485521201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 08/11/2017 | ||||||||
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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 | MT68505 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4416833 | 05 | MI | MEDICAID |