MEDICARE: VASUDEVAN MAHALINGAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	5151014298	MI

General Provider Information

NPI Number	:	1922620236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VASUDEVAN MAHALINGAM

Provider Business Mailing Address
First Line	:	1300 E WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-1051
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 E WARREN AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-1051
Country	:	US
Telephone Number	:	313-833-2563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2020
Last Update Date	:	06/03/2024

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Directions to “ VASUDEVAN MAHALINGAM ” Practice Location

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