Madhu Mahadevan, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901018150 Issued in MI

Practice address

28633 Hoover Rd
Warren, MI 48093-4105

Phone

(586) 751-3950

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Maria Elena Manzor DDS, P.C.

  • General Practice Dentistry
  • Warren, MI
  • NPI 1386835155
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1710070925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28633 HOOVER RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480934105",
            "telephone_number": "586-751-3950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28633 HOOVER RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480934105",
            "telephone_number": "586-751-3950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHADEVAN",
        "first_name": "MADHU",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901018150",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901018150",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1477147791",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madison Community Hospital Inc
• Rayeanne Magee
• Magnificent Home Help Agency LLC
• Maha Pharmacy LLC
• Maha Physical Therapy PLLC
• Sanganur V. Mahadevan, M.D.
• Amruta Mahajan
• Taha Mahmood, DPM
• Sulafa Saeed Babiker Mahmoud
• Charles Mahoney, DO

• General Practice Dentistry in Warren, MI
• Providers in Warren, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.