Provider Demographics
NPI:1194907576
Name:MANOHAR, ANAND MUKUND (MD)
Entity type:Individual
Prefix:DR
First Name:ANAND
Middle Name:MUKUND
Last Name:MANOHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 W PEARL ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1933
Mailing Address - Country:US
Mailing Address - Phone:517-278-7122
Mailing Address - Fax:517-279-4974
Practice Address - Street 1:87 W PEARL ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1933
Practice Address - Country:US
Practice Address - Phone:517-278-7122
Practice Address - Fax:517-279-4974
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033478207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0120844OtherBLUE SHIELD MICHIGAN
MI1398393Medicaid
0120844Medicare PIN
0120844OtherBLUE SHIELD MICHIGAN