Basic Information
| Provider Information | |||||||||
| NPI: | 1508013590 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAHESH | ||||||||
| FirstName: | SUJATHA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1300 MICCOSUKEE RD | ||||||||
| Address2: | HOSPITALIST GROUP | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504314556 | ||||||||
| FaxNumber: | 8504316315 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 MICCOSUKEE RD | ||||||||
| Address2: | HOSPITALIST GROUP | ||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504314556 | ||||||||
| FaxNumber: | 8504316315 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2008 | ||||||||
| LastUpdateDate: | 05/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301092449 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME114296 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.