Provider Demographics
NPI:1760638480
Name:MAHAN, DAVID ALAN (BCHIS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:MAHAN
Suffix:
Gender:M
Credentials:BCHIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18010 SILVER PKWY
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3421
Mailing Address - Country:US
Mailing Address - Phone:810-750-2626
Mailing Address - Fax:
Practice Address - Street 1:18010 SILVER PKWY
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3421
Practice Address - Country:US
Practice Address - Phone:810-750-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501000547237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI540B504180OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI540B504180OtherBLUE CROSS OF MICHIGAN
MI4987510Medicaid
MI540B50418OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI540B50418OtherHEALTH PLUS OF MICHIGAN