Provider Demographics
NPI:1245225416
Name:MAHAVIR, NICK ASHOK (DPM)
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:ASHOK
Last Name:MAHAVIR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 KELTON AVE
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-3175
Mailing Address - Country:US
Mailing Address - Phone:407-521-7999
Mailing Address - Fax:407-521-2227
Practice Address - Street 1:1140 KELTON AVE
Practice Address - Street 2:BLDG 3
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3175
Practice Address - Country:US
Practice Address - Phone:407-521-7999
Practice Address - Fax:407-521-2227
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO0003217213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340533800Medicaid
FL65906OtherBCBS
FL65906OtherBCBS
V07740Medicare UPIN