Provider Demographics
NPI:1891700662
Name:THU, GAMANI KYAW (MD)
Entity Type:Individual
Prefix:
First Name:GAMANI
Middle Name:KYAW
Last Name:THU
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 1:2201 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2843
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:
Practice Address - Street 1:2201 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2843
Practice Address - Country:US
Practice Address - Phone:606-408-4000
Practice Address - Fax:606-408-6825
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37983207Q00000X, 208M00000X
OH35072662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64068562Medicaid
OH2022420Medicaid
OH2022420Medicaid
G66413Medicare UPIN
OH0832556Medicare ID - Type Unspecified
KY64068562Medicaid
G66413Medicare UPIN
KY0264248Medicare ID - Type Unspecified
KY3400328Medicare ID - Type Unspecified
OH2022420Medicaid
KY0595302Medicare ID - Type Unspecified
OH0832557Medicare ID - Type Unspecified
OH4107261Medicare ID - Type Unspecified
KY3402061Medicare ID - Type Unspecified
P00022770Medicare ID - Type UnspecifiedRAIL ROAD
KY0586615Medicare ID - Type Unspecified
KY0632939Medicare ID - Type Unspecified