Provider Demographics
NPI:1386854602
Name:YS, MOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:
Last Name:YS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:YEDATHORE
Other - Middle Name:SUBBA RAO
Other - Last Name:MOHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2450 WALTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1481
Mailing Address - Country:US
Mailing Address - Phone:248-275-1144
Mailing Address - Fax:248-275-1146
Practice Address - Street 1:2450 WALTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1481
Practice Address - Country:US
Practice Address - Phone:248-275-1144
Practice Address - Fax:248-275-1146
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068711207T00000X
CAA104705207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery