Provider Demographics
NPI:1417680760
Name:MANOCHA, ALISHA RADHIKA (DO)
Entity type:Individual
Prefix:MS
First Name:ALISHA
Middle Name:RADHIKA
Last Name:MANOCHA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD PEDIATRICS - JACKSON
Mailing Address - Street 2:214 N W AVE
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201
Mailing Address - Country:US
Mailing Address - Phone:517-205-2700
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD PEDIATRICS - JACKSON
Practice Address - Street 2:214 N. WEST AVE
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201
Practice Address - Country:US
Practice Address - Phone:517-205-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2025-07-03
Deactivation Date:2023-03-13
Deactivation Code:
Reactivation Date:2023-03-29
Provider Licenses
StateLicense IDTaxonomies
MI5101028650208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics