1427058734 NPI number — MANHAR J TEJURA M.D.

Table of content: MANHAR J TEJURA M.D. (NPI 1427058734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427058734 NPI number — MANHAR J TEJURA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEJURA
Provider First Name:
MANHAR
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1427058734
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 N MACOMB ST
Provider Second Line Business Mailing Address:
STE 429
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48162-2900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-242-7060
Provider Business Mailing Address Fax Number:
734-241-7580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 N MACOMB ST
Provider Second Line Business Practice Location Address:
STE 429
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48162-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-242-7060
Provider Business Practice Location Address Fax Number:
734-241-7580
Provider Enumeration Date:
07/28/2005

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: 207RC0000X , with the licence number:  MT037750 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: 35043289T , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 25014177 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0429370 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102968533 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4054389 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: PARAMOUNT . This is a "01253" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 06005298 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0981811 . This is a "HEALTH PLAN OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4054389 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: D31195 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00959707 . This is a "RRMC" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000146865 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 25014177 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 700E860190 . This is a "BCBSMI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 06005298 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2316790 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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