Provider Demographics
NPI:1932258365
Name:MOHAN, KUMARAN K (MD)
Entity Type:Individual
Prefix:
First Name:KUMARAN
Middle Name:K
Last Name:MOHAN
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 1:1879 NIGHTINGALE LN
Mailing Address - Street 2:STE B3
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-4363
Mailing Address - Country:US
Mailing Address - Phone:352-589-9090
Mailing Address - Fax:352-589-1433
Practice Address - Street 1:4601 N HIGHWAY 19A
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-2039
Practice Address - Country:US
Practice Address - Phone:352-589-9090
Practice Address - Fax:352-589-1433
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265990500Medicaid
FL62884Medicare ID - Type Unspecified
FLG59618Medicare UPIN