Provider Demographics
NPI:1639399249
Name:MOHAMMAD A. MIAN, MD PSC
Entity Type:Organization
Organization Name:MOHAMMAD A. MIAN, MD PSC
Other - Org Name:KENTUCKIANA PSYCHOTHERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:JACOBS
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-499-9993
Mailing Address - Street 1:9017 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1749
Mailing Address - Country:US
Mailing Address - Phone:502-499-9993
Mailing Address - Fax:502-495-0758
Practice Address - Street 1:9017 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1749
Practice Address - Country:US
Practice Address - Phone:502-499-9993
Practice Address - Fax:502-495-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4251041C0700X
KY22242174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65917932Medicaid
IN100116470Medicaid
KY64222425Medicaid
KY82004250Medicaid
IN200055430Medicaid
KY82900036Medicaid
IN100116470Medicaid
KY1530202Medicare PIN
KYR36860Medicare UPIN
KY82004250Medicaid
KY65917932Medicaid