1417680760 NPI number — MS. ALISHA RADHIKA MANOCHA D.O.

Table of content: MS. ALISHA RADHIKA MANOCHA D.O. (NPI 1417680760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417680760 NPI number — MS. ALISHA RADHIKA MANOCHA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MANOCHA
Provider First Name:
ALISHA
Provider Middle Name:
RADHIKA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417680760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/13/2023
NPI Reactivation Date:
03/29/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HENRY FORD PEDIATRICS - JACKSON
Provider Second Line Business Mailing Address:
214 N W AVE
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-205-2700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HENRY FORD PEDIATRICS - JACKSON
Provider Second Line Business Practice Location Address:
214 N. WEST AVE
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-205-2700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  5101028650 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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