Provider Demographics
NPI:1366426454
Name:MISRA HIGGINS, INDIRA (DO PLLC)
Entity type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:MISRA HIGGINS
Suffix:
Gender:F
Credentials:DO PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31815 SOUTHFIELD RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5471
Mailing Address - Country:US
Mailing Address - Phone:248-723-5802
Mailing Address - Fax:248-723-5838
Practice Address - Street 1:31815 SOUTHFIELD RD
Practice Address - Street 2:SUITE 18
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5471
Practice Address - Country:US
Practice Address - Phone:248-723-5802
Practice Address - Fax:248-723-5838
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012883207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI1077OtherMEDICARE PTAN
H21630Medicare UPIN