Individual
MR. MADHU MAHADEVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
28633 HOOVER RD, WARREN, MI 48093-4105
(586) 751-3950
Mailing address
28633 HOOVER RD, WARREN, MI 48093-4105
(586) 751-3950
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
2901018150
MI
1223G0001X
General Practice Dentistry
Primary
2901018150
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1477147791
BCBS
MI
Enumeration date
10/02/2006
Last updated
07/12/2023
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