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General NPI Number Information
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NPI Number | 1912240698
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Entity Type | Individual
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Provider Name | MUDALODU VEERARAGHAVACHAR VASUDEVAN MD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 04/01/2013
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Provider Practice Location Address
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Address Line | 4303 PITMAN ST
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City | LAWTON
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State | OK
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Zip | 73503-4473
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Country | US
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Telephone | 646-688-3579
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Fax |
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Provider Business Mailing Address
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Address Line | 3160 WILDWOOD DRIVE 317
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City | WINDSOR
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State | ONTARIO
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Zip | N8R2K8
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Country | CA
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Telephone | 646-688-3579
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine
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License Number | 4301102270
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License Number State | MI
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