Organization
JAY MAHADEVAN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY MAHADEVAN MD (PRESIDENT)
(314) 865-6582
Entity
Organization
Contact information
Practice address
3535 S JEFFERSON AVE, SUITE 304, ST LOUIS, MO 63118
(314) 865-6585
(314) 865-6599
Mailing address
PO BOX 775578, ST LOUIS, MO 63177-5578
(314) 865-6582
(314) 865-6599
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0400415
UHC
MO
01
—
100656
BLUE SHIELD
MO
05
—
201582608
—
MO
Enumeration date
09/07/2006
Last updated
08/05/2010
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