Healthcare Provider Details

I. General information

NPI: 1225087208
Provider Name (Legal Business Name): BEEJADI N MUKUNDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6559 WILSON MILLS RD STE 106A
MAYFIELD VILLAGE OH
44143-3433
US

IV. Provider business mailing address

PO BOX 952041
CLEVELAND OH
44193-0051
US

V. Phone/Fax

Practice location:
  • Phone: 855-449-1540
  • Fax: 440-672-5068
Mailing address:
  • Phone: 855-449-1540
  • Fax: 440-672-5068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35073940
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: