Individual
MABBU GAJAPATHY SHIVAPRASAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
LOGAN FAMILY MEDICAL CENTER LLC, 2210 TIMBER TRAIL, BELLEFONTAINE, OH 43311
(937) 593-3151
(937) 593-5438
Mailing address
2210 TIMBER TRAIL, BELLEFONTAINE, OH 43311
(937) 593-3151
(937) 593-5438
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-072257
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2017373
—
OH
Enumeration date
10/18/2006
Last updated
07/08/2007
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