Provider Demographics
NPI:1720198013
Name:MULAY, RAMAKANT MAHADEO (MD)
Entity Type:Individual
Prefix:
First Name:RAMAKANT
Middle Name:MAHADEO
Last Name:MULAY
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 1:1575 PARR AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-3151
Mailing Address - Country:US
Mailing Address - Phone:731-286-1510
Mailing Address - Fax:731-286-2662
Practice Address - Street 1:1575 PARR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3151
Practice Address - Country:US
Practice Address - Phone:731-286-1510
Practice Address - Fax:731-286-2662
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD017125207RN0300X
MO109397207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000000294177OtherANTHEM BCBS OF KY
TN117246Medicaid
MO172300OtherBLUE CROSS BLUE SHIELD OF
MO202308359Medicaid
TN4602926OtherAETNA HMO
TN0061459OtherBLUE CROSS BLUE SHIELD OF
TN621284167OtherTRICARE SOUTH REGION
TN621284167Medicaid
TN392995OtherHEALTHLINK
TN61459Medicaid
MO621284167OtherALL COMMERCIAL INSURANCE
TN1504871Medicaid
TN621284167OtherALL COMMERCIAL INSURANCE
TN6312Medicaid
MO390008730Medicare PIN
TN621284167OtherTRICARE SOUTH REGION
TN392995OtherHEALTHLINK
TN30205911Medicare PIN
TN4602926OtherAETNA HMO
MO202308359Medicaid