Provider Demographics
NPI:1730386913
Name:MANHAL W TOBIA M.D., P.C.
Entity type:Organization
Organization Name:MANHAL W TOBIA M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:SHAMOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-552-1200
Mailing Address - Street 1:18161 W 12 MILE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LATHRUP VILLAGE
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2662
Mailing Address - Country:US
Mailing Address - Phone:248-552-1200
Mailing Address - Fax:248-552-1201
Practice Address - Street 1:18161 W 12 MILE RD STE 2
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-2662
Practice Address - Country:US
Practice Address - Phone:248-552-1200
Practice Address - Fax:248-552-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMT068505305R00000X
MI4301068505173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1730386913Other06338982
MI1730386913OtherGROUP NPI
MI1730386913OtherGROUP NPI