Basic Information
Provider Information
NPI: 1003143231
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ENSHIWAT
FirstName: MANDY
MiddleName: LUMA
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6255 INKSTER RD
Address2: SUITE 101
City: GARDEN CITY
State: MI
PostalCode: 481352577
CountryCode: US
TelephoneNumber: 7344214850
FaxNumber: 7344216635
Practice Location
Address1: 6255 INKSTER RD
Address2: SUITE 101
City: GARDEN CITY
State: MI
PostalCode: 481352577
CountryCode: US
TelephoneNumber: 7344214850
FaxNumber: 7344216635
Other Information
ProviderEnumerationDate: 11/09/2009
LastUpdateDate: 04/12/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X4301095446MIY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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