1053393702 NPI number — DR. MAHESH C KARAMCHANDANI MD

Table of content: DR. MAHESH C KARAMCHANDANI MD (NPI 1053393702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053393702 NPI number — DR. MAHESH C KARAMCHANDANI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARAMCHANDANI
Provider First Name:
MAHESH
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053393702
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 JOHN ST
Provider Second Line Business Mailing Address:
BOX 42
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49007-5341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-341-8419
Provider Business Mailing Address Fax Number:
269-341-8743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3770 CAPITAL AVE SW
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BATTLE CREEK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49015-9411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-441-1771
Provider Business Practice Location Address Fax Number:
269-441-1773
Provider Enumeration Date:
11/17/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208C00000X , with the licence number:  MD050945 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 107550 . This is a "PREFERRED CHOICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14-30422 . This is a "PHYSICIANS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4656315 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P56096 . This is a "BLUE CARE NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 280000146 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2962398 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1053393702 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 383125785103 . This is a "COMMUNITY CHOICE OF MI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 101572 . This is a "GREAT LAKES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9531910 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1417961137 . This is a "BCBSM - BRONSON" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: M012958 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".