Provider Demographics
NPI:1942288402
Name:MINHAS, IMRAN T (MD)
Entity Type:Individual
Prefix:
First Name:IMRAN
Middle Name:T
Last Name:MINHAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2830 VICTORY PKWY
Mailing Address - Street 2:LL30
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-245-3306
Mailing Address - Fax:513-475-7259
Practice Address - Street 1:8006 KINGFISHER LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-1948
Practice Address - Country:US
Practice Address - Phone:513-522-4600
Practice Address - Fax:513-522-4658
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087059207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2630586Medicaid
OHP00395114OtherRR MEDICARE
OHH061770Medicare PIN
OHP00395114OtherRR MEDICARE
OH4175615Medicare PIN