Individual
NIVEDITHA SHIVAKUMAR MUDEGOWDRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
805 JOHN ST, KALAMAZOO, MI 49001
(269) 286-7170
Mailing address
31244 COUNTRY WAY, FARMINGTON HILLS, MI 48331-1041
(248) 661-1262
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301105276
MI
207RH0003X
Hematology & Oncology Physician
Primary
4301105276
MI
Other
Enumeration date
04/09/2014
Last updated
08/08/2022
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