Provider Demographics
NPI:1316134695
Name:DEV MAHAJAN, M.D.,P.C.
Entity type:Organization
Organization Name:DEV MAHAJAN, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEV
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MDPC
Authorized Official - Phone:313-292-3500
Mailing Address - Street 1:10501 TELEGRAPH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3375
Mailing Address - Country:US
Mailing Address - Phone:313-292-3500
Mailing Address - Fax:313-292-3503
Practice Address - Street 1:10501 TELEGRAPH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3375
Practice Address - Country:US
Practice Address - Phone:313-292-3500
Practice Address - Fax:313-292-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDM037664207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1400007Medicaid
MI1400007Medicaid
MID83204Medicare UPIN
MI0P43560Medicare PIN