Provider Demographics
NPI:1104891704
Name:MAHADEVIA, AKSHAY KANTILAL (MD)
Entity type:Individual
Prefix:DR
First Name:AKSHAY
Middle Name:KANTILAL
Last Name:MAHADEVIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 DEXTER CT STE 102
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3471
Mailing Address - Country:US
Mailing Address - Phone:563-323-1352
Mailing Address - Fax:855-274-1654
Practice Address - Street 1:3385 DEXTER CT STE 102
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-323-1352
Practice Address - Fax:855-274-1654
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059280207RP1001X
IA23595207RP1001X
TN51566207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1025718Medicaid
IA290001149OtherRAILROAD MEDICARE
IL290010032OtherRAILROAD MEDICARE
IL290010032OtherRAILROAD MEDICARE
IAA03896Medicare UPIN
IA077404Medicare ID - Type Unspecified