Provider Demographics
NPI:1528050721
Name:MISHRA, KABINDRA N (MD)
Entity type:Individual
Prefix:DR
First Name:KABINDRA
Middle Name:N
Last Name:MISHRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KABINDRA
Other - Middle Name:N
Other - Last Name:MISHRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1100 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1847
Mailing Address - Country:US
Mailing Address - Phone:517-787-3900
Mailing Address - Fax:517-787-4318
Practice Address - Street 1:1100 E MICHIGAN AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1847
Practice Address - Country:US
Practice Address - Phone:517-787-3900
Practice Address - Fax:517-787-4318
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:2006-04-28
Deactivation Code:
Reactivation Date:2006-04-28
Provider Licenses
StateLicense IDTaxonomies
MI4301033204207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381017OtherBLUE CROSS BLUE SHIELD MI
MIP58871OtherBLUE CARE NETWORK
MI1196630001OtherMEDICARE DMERC
MI0920070OtherPHYSICIANS HEALTH PLAN
MI3810173012Medicare ID - Type Unspecified
MI381017OtherBLUE CROSS BLUE SHIELD MI