Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 4301063655 | MI |
N | 208000000X | Pediatrician | 4301063655 | MI |
NPI | 1508803008 |
---|---|
Provider Name | Prashant Vithal Mahajan |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-4205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 14/09/2016 |