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Individual

DR. MUDALODU VEERARAGHAVACHAR VASUDEVAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2470 E FLAMINGO RD STE D, LAS VEGAS, NV 89121-5200
(702) 544-3849
Mailing address
164 W INVITAR LN, MTN HOUSE, CA 95391-2036

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17489
NV
207Q00000X
Family Medicine Physician
4301102270
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4301102270
MEDICAL LICENSE
MI
01
5315058571
PHARMACY LICENSE CONTROLLED SUBSTANCE NUMBER
MI
Enumeration date
04/01/2013
Last updated
11/18/2017
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