Provider Demographics
NPI:1427058734
Name:TEJURA, MANHAR J (MD)
Entity type:Individual
Prefix:
First Name:MANHAR
Middle Name:J
Last Name:TEJURA
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 1:730 N MACOMB ST
Mailing Address - Street 2:STE 429
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-2900
Mailing Address - Country:US
Mailing Address - Phone:734-242-7060
Mailing Address - Fax:734-241-7580
Practice Address - Street 1:730 N MACOMB ST
Practice Address - Street 2:STE 429
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2900
Practice Address - Country:US
Practice Address - Phone:734-242-7060
Practice Address - Fax:734-241-7580
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMT037750207RC0000X
OH35043289T207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI25014177OtherUNITED HEALTHCARE
OH0429370Medicaid
MI102968533Medicaid
OH4054389OtherAETNA
OHPARAMOUNTOther01253
MI06005298OtherMEDICARE RAILROAD
MI0981811OtherHEALTH PLAN OF MI
MI4054389OtherAETNA
MID31195OtherHEALTH ALLIANCE PLAN
MIP00959707OtherRRMC
OH000000146865OtherANTHEM BCBS
OH25014177OtherUNITED HEALTHCARE
MI700E860190OtherBCBSMI
OH06005298OtherMEDICARE RAILROAD
OH2316790OtherCIGNA
MID31195Medicare UPIN
MIMI4479002Medicare PIN
OH25014177OtherUNITED HEALTHCARE
MI4054389OtherAETNA