Healthcare Provider Details

I. General information

NPI: 1790750974
Provider Name (Legal Business Name): VINIT KUMAR MAHESH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 GOVERNORS DR SW
HUNTSVILLE AL
35801-5126
US

IV. Provider business mailing address

502 GOVERNORS DR SW
HUNTSVILLE AL
35801-5126
US

V. Phone/Fax

Practice location:
  • Phone: 256-533-0833
  • Fax: 256-533-0855
Mailing address:
  • Phone: 256-533-0833
  • Fax: 256-533-0855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number15646
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: