Provider Demographics
NPI:1972923274
Name:MADHAVAN, DEVIKA (MD)
Entity Type:Individual
Prefix:
First Name:DEVIKA
Middle Name:
Last Name:MADHAVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 W BRAKER LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-3801
Mailing Address - Country:US
Mailing Address - Phone:512-978-9300
Mailing Address - Fax:
Practice Address - Street 1:1210 W BRAKER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-3801
Practice Address - Country:US
Practice Address - Phone:512-978-9300
Practice Address - Fax:512-978-9737
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS4187207RE0101X
MI4301104783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism