Basic Information
| Provider Information | |||||||||
| NPI: | 1821122169 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RAMESH K MOHINDRA MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14555 LEVAN RD | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481545083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347792123 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14555 LEVAN RD | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481545083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347792123 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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| AuthorizedOfficialLastName: | MOHINDRA | ||||||||
| AuthorizedOfficialFirstName: | RAMESH | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7347792123 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 4301033586 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1108238712 | 01 | MI | BCBS OF MI | OTHER | 0829730 | 01 | MI | MEDICARE PLUS BLUE | OTHER |