Provider Demographics
NPI:1790876407
Name:JHAMB, INDAR MOHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:INDAR
Middle Name:MOHAN
Last Name:JHAMB
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 1:186 TALBOTT DR
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-1322
Mailing Address - Country:US
Mailing Address - Phone:270-782-0466
Mailing Address - Fax:
Practice Address - Street 1:1217 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3383
Practice Address - Country:US
Practice Address - Phone:270-782-3237
Practice Address - Fax:270-782-1412
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20856207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000-550426OtherBS
KY1790983377OtherMEDICAID NPI
KYK004831OtherCHAMPUS
TN0028731OtherBCBS
02-00002OtherUH
4263926OtherAETNA
61101OtherHUMANA
KY64208564Medicaid
KY45641453OtherEPSDT
18D0325833OtherCLIA
6368OtherCHA
KY000000048215OtherBCBS
7305OtherALTERNATIVE HEALTH
7305V665.1OtherGE
P020OtherHEALTHWISE
KY1790983377OtherMEDICAID NPI