Individual
DR. MOHAN REDDI NANDALUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1215 N BEAVER STREET, HEART & VASCULAR CENTER OF NORTHERN ARIZONA, FLAGSTAFF, AZ 86001-3118
(703) 587-3913
Mailing address
PO BOX 98356, PHOENIX, AZ 85038-0365
(703) 587-3913
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
11895
MT
207RC0000X
Cardiovascular Disease Physician
D64943
MD
207RI0011X
Interventional Cardiology Physician
11895
MT
207RI0011X
Interventional Cardiology Physician
Primary
D64943
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000085424
MEDICARE GROUP NUMBER
MT
05
—
15171
—
ND
05
—
155173
—
MD
Enumeration date
06/17/2006
Last updated
02/10/2012
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