Provider Demographics
NPI:1497138838
Name:MOHAN, VISHNU (MD)
Entity Type:Individual
Prefix:
First Name:VISHNU
Middle Name:
Last Name:MOHAN
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 1:3833 DUNLAVY ST APT 339
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-4750
Mailing Address - Country:US
Mailing Address - Phone:832-908-1441
Mailing Address - Fax:713-500-6497
Practice Address - Street 1:11476 SPACE CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77059-3656
Practice Address - Country:US
Practice Address - Phone:713-486-6325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-02
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS7505207RR0500X
IL036154227207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology