Provider Demographics
NPI:1003133141
Name:K MOHAN MD PC
Entity Type:Organization
Organization Name:K MOHAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:K
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1989-892-5302
Mailing Address - Street 1:714 S TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-4217
Mailing Address - Country:US
Mailing Address - Phone:198-989-2530
Mailing Address - Fax:198-989-2469
Practice Address - Street 1:714 S TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-4217
Practice Address - Country:US
Practice Address - Phone:198-989-2530
Practice Address - Fax:198-989-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIKMO37321207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003133141OtherNPI GROUP
MI104347665Medicaid
MION83590Medicare PIN
MI1003133141OtherNPI GROUP