Provider Demographics
NPI:1457580490
Name:ASHRAF, KOMAL HARGOVIND (DO)
Entity Type:Individual
Prefix:DR
First Name:KOMAL
Middle Name:HARGOVIND
Last Name:ASHRAF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KOMAL
Other - Middle Name:HARGOVIND
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2100 SILVA LN STE A
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3678
Mailing Address - Country:US
Mailing Address - Phone:660-263-7201
Mailing Address - Fax:660-263-2260
Practice Address - Street 1:525 N. KEENE ST. STE 301
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201
Practice Address - Country:US
Practice Address - Phone:573-449-2141
Practice Address - Fax:573-875-2328
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004264A2084N0400X
MO20150309402084N0400X, 2084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201172410Medicaid
IN000000881931OtherANTHEM BCBS
IN201172410Medicaid