Healthcare Provider Details

I. General information

NPI: 1043401821
Provider Name (Legal Business Name): MIHIR M PRADHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E SOUTH BLVD BAPTIST MEDICAL CENTER SOUTH
MONTGOMERY AL
36116-2409
US

IV. Provider business mailing address

440 TAYLOR ROAD SUITE 3380
MONTGOMERY AL
36117-3587
US

V. Phone/Fax

Practice location:
  • Phone: 334-286-2987
  • Fax: 334-286-3368
Mailing address:
  • Phone: 334-213-6287
  • Fax: 334-213-6288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD28297
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.28297
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: