Provider Demographics
NPI:1003000902
Name:LOHANO, JAIVANTI (MD)
Entity Type:Individual
Prefix:
First Name:JAIVANTI
Middle Name:
Last Name:LOHANO
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 1:2215 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40212-1033
Mailing Address - Country:US
Mailing Address - Phone:502-774-8631
Mailing Address - Fax:502-778-3499
Practice Address - Street 1:2215 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-1033
Practice Address - Country:US
Practice Address - Phone:502-774-8631
Practice Address - Fax:502-778-3499
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063381A207Q00000X
KY41402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100065920Medicaid
KY0795640Medicare PIN
KY0538689Medicare PIN
KY00714037Medicare PIN
KY00640004Medicare PIN
KY7100065920Medicaid
KY0538789Medicare PIN
KY0538587Medicare PIN