Individual
DR. VENNARALAGAPPAN MAHADEV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1721 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-3637
(906) 774-1313
Mailing address
1721 S STEPHENSON AVE, IRON MOUNTAIN, MI 49801-3637
(906) 774-1313
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
043493
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2116604
—
MI
05
—
30416500
—
WI
Enumeration date
10/06/2005
Last updated
01/15/2020
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