Individual
MAHATHI KEELAPANDAL GANESH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3110
Mailing address
2927 FISHERMANS CV APT 203, LAKE ORION, MI 48360-2603
(248) 607-0780
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125080023
IL
207R00000X
Internal Medicine Physician
Primary
4301513505
MI
Other
Enumeration date
08/09/2022
Last updated
07/22/2025
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