Provider Demographics
NPI:1124076831
Name:MOOLANI, MAHESH K (MD)
Entity type:Individual
Prefix:
First Name:MAHESH
Middle Name:K
Last Name:MOOLANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 BRECKENRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1090
Mailing Address - Country:US
Mailing Address - Phone:270-684-0028
Mailing Address - Fax:270-685-8233
Practice Address - Street 1:1200 BRECKENRIDGE ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1090
Practice Address - Country:US
Practice Address - Phone:270-685-8224
Practice Address - Fax:270-685-8228
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY38505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000514448OtherATNEM BLUE CROSS AND BLUE SHEILD
KY64090731Medicaid
KYP00473282OtherRR MEDICARE
KYI11299Medicare UPIN
KYP00473282OtherRR MEDICARE
KY0665333Medicare ID - Type Unspecified