Provider Demographics
NPI:1942262506
Name:KHOSRAVI, MEHDI (MD)
Entity Type:Individual
Prefix:
First Name:MEHDI
Middle Name:
Last Name:KHOSRAVI
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:UNIVERSITY OF KENTUCKY
Mailing Address - Street 2:740 SOUTH LIMESTONE STREET, L543 KENTUCKY CLINIC
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-5045
Mailing Address - Fax:859-257-2418
Practice Address - Street 1:UNIVERSITY OF KENTUCKY
Practice Address - Street 2:740 SOUTH LIMESTONE STREET, L543 KENTUCKY CLINIC
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-5045
Practice Address - Fax:859-257-2418
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY40372207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYI63855Medicare UPIN
767605Medicare PIN