Individual
VIDUR SIDDHANTH MAHADEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 E WILLIAMS AVE, FALLON, NV 89406-3052
(775) 423-3151
(775) 423-2853
Mailing address
1441 N 12TH ST, PHOENIX, AZ 85006-2837
(602) 495-4577
(602) 417-3549
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11257
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100508290
—
NV
Enumeration date
03/14/2006
Last updated
11/30/2012
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