Provider Demographics
NPI:1316795776
Name:MAHAL, MANVEER KAUR (MD)
Entity type:Individual
Prefix:MS
First Name:MANVEER
Middle Name:KAUR
Last Name:MAHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:TRINITY HEALTH LIVONIA HOSPITAL
Mailing Address - Street 2:36475 FIVE MILE RD
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:TRINITY HEALTH ACADEMIC FAMILY MEDICINE NORTHWEST LIVON
Practice Address - Street 2:37595 SEVEN MILE RD, SUITE 210
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-853-5690
Practice Address - Fax:734-430-9388
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program