Healthcare Provider Details

I. General information

NPI: 1447298914
Provider Name (Legal Business Name): CHELLAPPAH MAHESWARAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE ROOM 4172
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1143 OBISPO AVE
CORAL GABLES FL
33134-3557
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5116
  • Fax:
Mailing address:
  • Phone: 305-476-8972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberME 31574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: