Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 45084 | WA |
Y | 207RI0011X | Interventional Cardiology | MD00045084 | WA |
NPI | 1013972488 |
---|---|
Provider Name | Mahesh Mulumudi |
First Address | Everett, WA 98206-5127 |
Second Address | Everett, WA 98201-4918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 09/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1000439 | (05) | WA |
H41356 | (02) |