Individual
SANGANUR V. MAHADEVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11477 E 12 MILE RD, WARREN, MI 48093-2678
(586) 751-0200
(586) 751-0414
Mailing address
11477 E 12 MILE RD, WARREN, MI 48093-2678
(586) 751-0200
(586) 751-0414
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
4301033200
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-08067781
BCBSM
MI
05
—
2095952
—
MI
Enumeration date
05/23/2006
Last updated
07/08/2007
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