Individual
MAHAVEER MUKKAMALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
204 S BELLEVUE AVE, DOVER, OH 44622-9405
(330) 343-7950
(330) 343-7805
Mailing address
204 S BELLEVUE AVE, DOVER, OH 44622-9405
(330) 343-7950
(330) 343-7805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35.095311
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35.095311
OHIO LICENSE
OH
Enumeration date
08/15/2007
Last updated
11/27/2013
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