Provider Demographics
NPI:1063519718
Name:RAO, MOHAN K (MD)
Entity type:Individual
Prefix:
First Name:MOHAN
Middle Name:K
Last Name:RAO
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 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1658
Practice Address - Country:US
Practice Address - Phone:270-326-4800
Practice Address - Fax:270-326-4820
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21551208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64215510Medicaid
KY21551OtherLICENSE
000000044265OtherBCBS PROVIDER NUMBER
0691612Medicare PIN
000000044265OtherBCBS PROVIDER NUMBER
C67494Medicare UPIN
KY64215510Medicaid
KY020046061Medicare PIN
KY00280139Medicare PIN
0375108Medicare PIN
KYK076330Medicare PIN
0374595Medicare PIN
KY0601462Medicare PIN