1346242591 NPI number — MANOHAR ATRI MD

Table of content: MANOHAR ATRI MD (NPI 1346242591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346242591 NPI number — MANOHAR ATRI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATRI
Provider First Name:
MANOHAR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1346242591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/20/2006
NPI Reactivation Date:
05/17/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4855 BERL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAGINAW
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48604-2801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-799-8000
Provider Business Mailing Address Fax Number:
989-799-8797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4855 BERL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAGINAW
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48604-2801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-799-8000
Provider Business Practice Location Address Fax Number:
989-799-8797
Provider Enumeration Date:
06/01/2005

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: 207RN0300X , with the licence number:  486605 , 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)

  • Identifier: 1107309722 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: C3336 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: E82654 . This is a "PALMETTO GBA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1078667 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1001269 . This is a "MCCLAREN HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3127406 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31814 . This is a "PRIORITY HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383225867991 . This is a "COMMUNITY CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4219281 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383225867 . This is a "HUMANA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383225867 . This is a "TRICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P64820 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1107309721 . This is a "SAGINAW HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 3127406 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: HUMANA CHOICE . This is a "383225867" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1107309721 . This is a "HEALTH PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 118391 . This is a "GREAT LAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383225867 . This is a "TRICARE FOR LIFE NORTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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