Provider Demographics
NPI:1780665174
Name:MAHAN, JOHN T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:MAHAN
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 1:18 VILLAGE PLZ
Mailing Address - Street 2:PMB 136
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065
Mailing Address - Country:US
Mailing Address - Phone:502-633-0192
Mailing Address - Fax:502-633-4164
Practice Address - Street 1:1741 MIDLAND TRL
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1711
Practice Address - Country:US
Practice Address - Phone:502-633-0192
Practice Address - Fax:502-633-0192
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28822207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50040687OtherPASSPORT (JPG)
IN200143910A/BMedicaid
KY64288228Medicaid
KYK051420 (JPG)Medicare PIN
IN228550003JPGMEDICAREMedicare PIN
KY50040687OtherPASSPORT (JPG)
KYP01088354-JPG/RRMedicare PIN
KY0239345Medicare PIN
IN200143910A/BMedicaid