Provider Demographics
NPI:1811920390
Name:SHRIDHARANI, MAHAVIR K (MD)
Entity type:Individual
Prefix:DR
First Name:MAHAVIR
Middle Name:K
Last Name:SHRIDHARANI
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 1:514 BURKARTH RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-3104
Mailing Address - Country:US
Mailing Address - Phone:660-429-2128
Mailing Address - Fax:660-429-3615
Practice Address - Street 1:514 BURKARTH RD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-3104
Practice Address - Country:US
Practice Address - Phone:660-429-2128
Practice Address - Fax:660-429-3615
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1A87207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201157310Medicaid
MOT994306Medicare ID - Type Unspecified
MO201157310Medicaid