Provider Demographics
NPI:1790725158
Name:KULKARNI, MOHAN GANESH (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:GANESH
Last Name:KULKARNI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:900 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-2457
Mailing Address - Country:US
Mailing Address - Phone:517-788-6007
Mailing Address - Fax:517-788-6438
Practice Address - Street 1:900 E MICHIGAN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2457
Practice Address - Country:US
Practice Address - Phone:517-788-6007
Practice Address - Fax:517-788-6438
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301066998208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMK066998OtherSTATE LICENSE