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Individual

MAHLON VANDELDEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1000 W NIFONG BLVD, BUILDING 3, SUITE 100, COLUMBIA, MO 65203-5615
(573) 214-2000
(573) 214-2042
Mailing address
1000 W NIFONG BLVD, BUILDING 3, SUITE 100, COLUMBIA, MO 65203-5615
(573) 214-2000
(573) 214-2042

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01048581A
IN
207Y00000X
Otolaryngology Physician
Primary
101110
MO
207Y00000X
Otolaryngology Physician
34110
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000045661
ANTHEM
IN
01
000000045661
ANTHEM
KY
01
040013796
RR MEDICARE
KY
01
065102
HEALTH ALLIANCE
IN
05
200181080A
IN
01
382908
HEALTHLINK
IN
05
64341019
KY
01
P00153580
RR MEDICARE
IN
Enumeration date
10/17/2005
Last updated
02/17/2011
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