Active NPI
Manisha Guntha, M.D
- Student in an Organized Health Care Education/Training Program
- Detroit, MI
National Provider Identifier
1740979004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 6071 Outer Dr West
Detroit, MI 48235 - Phone
- (313) 966-3300
- Fax
- (313) 993-8501
- NPI assigned
- May 3, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
6071 Outer Dr West
Detroit, MI 48235
Mailing address
6071 Outer Dr West
Detroit, MI 48235
Phone (313) 966-3300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4351051492 | Other | MI | MICHIGAN MEDICAL DOCTOR EDUCATIONAL LIMITED LICNESE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231115000751 | MI | Order and Referring Only - Internal Medicine | 3971950874 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693526400000",
"number": "1740979004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6071 OUTER DR WEST",
"city": "DETROIT",
"state": "MI",
"postal_code": "48235",
"telephone_number": "313-966-3300",
"fax_number": "313-993-8501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6071 OUTER DR WEST",
"city": "DETROIT",
"state": "MI",
"postal_code": "48235",
"telephone_number": "313-966-3300",
"fax_number": "313-993-8501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUNTHA",
"first_name": "MANISHA",
"credential": "M.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-03",
"last_updated": "2023-09-01",
"certification_date": "2023-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MICHIGAN MEDICAL DOCTOR EDUCATIONAL LIMITED LICNESE",
"identifier": "4351051492",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.