Provider Demographics
NPI:1104816586
Name:MHASKAR, NILESH SURESH (MD)
Entity type:Individual
Prefix:
First Name:NILESH
Middle Name:SURESH
Last Name:MHASKAR
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 1:500 LINCOLN PARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-6410
Mailing Address - Country:US
Mailing Address - Phone:937-222-3118
Mailing Address - Fax:937-222-1436
Practice Address - Street 1:500 LINCOLN PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-6410
Practice Address - Country:US
Practice Address - Phone:937-222-3118
Practice Address - Fax:937-222-1436
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090016207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
059456Medicare ID - Type Unspecified
H65588Medicare UPIN