Basic Information
| Provider Information | |||||||||
| NPI: | 1750540233 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAITHEL | ||||||||
| FirstName: | SHISHIR | ||||||||
| MiddleName: | KUMAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1365 C CLIFTON RD NE | ||||||||
| Address2: | SUITE C2018 2ND FL | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047781903 | ||||||||
| FaxNumber: | 4047784490 | ||||||||
| Practice Location | |||||||||
| Address1: | 101W PONCE DE LEON AVE | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300302528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047785014 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2008 | ||||||||
| LastUpdateDate: | 07/21/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | 062739 | GA | Y | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology |
No ID Information.