Provider Demographics
NPI:1851447072
Name:MAZLOOMDOOST, DANESH (MD)
Entity Type:Individual
Prefix:DR
First Name:DANESH
Middle Name:
Last Name:MAZLOOMDOOST
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 1:715 SHAKER DRIVE
Mailing Address - Street 2:SUITE #132
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3663
Mailing Address - Country:US
Mailing Address - Phone:859-275-4878
Mailing Address - Fax:859-276-5400
Practice Address - Street 1:715 SHAKER DRIVE
Practice Address - Street 2:SUITE #132
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3663
Practice Address - Country:US
Practice Address - Phone:859-275-4878
Practice Address - Fax:859-276-5400
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43582207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100117480Medicaid