Provider Demographics
NPI:1285673129
Name:MISHAL, DEVADATT MADHUKAR (MD)
Entity Type:Individual
Prefix:
First Name:DEVADATT
Middle Name:MADHUKAR
Last Name:MISHAL
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 1:8500 FLORENCE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-4054
Mailing Address - Country:US
Mailing Address - Phone:562-869-4579
Mailing Address - Fax:562-862-1765
Practice Address - Street 1:8500 FLORENCE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-4054
Practice Address - Country:US
Practice Address - Phone:562-869-4579
Practice Address - Fax:562-862-1765
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36594207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23136Medicare UPIN
WA36594DMedicare ID - Type Unspecified