Provider Demographics
NPI:1043401821
Name:PRADHAN, MIHIR M (MD)
Entity Type:Individual
Prefix:MR
First Name:MIHIR
Middle Name:M
Last Name:PRADHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:440 TAYLOR ROAD
Mailing Address - Street 2:SUITE 3380
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3587
Mailing Address - Country:US
Mailing Address - Phone:334-213-6287
Mailing Address - Fax:334-213-6288
Practice Address - Street 1:2105 E SOUTH BLVD
Practice Address - Street 2:BAPTIST MEDICAL CENTER SOUTH
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2409
Practice Address - Country:US
Practice Address - Phone:334-286-2987
Practice Address - Fax:334-286-3368
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD28297207Q00000X
ALMD.28297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630902090Medicaid
AL515-98983OtherBLUE CROSS/BLUE SHIELD
AL515-98983OtherBLUE CROSS/BLUE SHIELD