Provider Demographics
NPI:1487624052
Name:MAHAJAN, DEVINDER (MD)
Entity type:Individual
Prefix:
First Name:DEVINDER
Middle Name:
Last Name:MAHAJAN
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 1:2723 S STATE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-6188
Mailing Address - Country:US
Mailing Address - Phone:734-316-7880
Mailing Address - Fax:888-837-9061
Practice Address - Street 1:18181 OAKWOOD BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-5031
Practice Address - Country:US
Practice Address - Phone:313-271-5565
Practice Address - Fax:313-271-1053
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037664207RS0012X
MIDM037664207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI602025OtherULTIMED
MI116895OtherCARE CHOICE
MI1400007Medicaid
MIC5498OtherM-CARE
MI016437400OtherBLACK LUNG
MI2908246371OtherBCBS
MI4440214OtherTEAMSTERS
MI4440214OtherTEAMSTERS
MI0824637Medicare ID - Type Unspecified