Provider Demographics
NPI:1215142401
Name:DOSANI, IMRAN (MD)
Entity type:Individual
Prefix:
First Name:IMRAN
Middle Name:
Last Name:DOSANI
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 1:1020 WATERFALL CT
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-8079
Mailing Address - Country:US
Mailing Address - Phone:270-821-5726
Mailing Address - Fax:270-326-2090
Practice Address - Street 1:1020 WATERFALL CT
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-8079
Practice Address - Country:US
Practice Address - Phone:270-821-5726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44105207R00000X, 207RN0300X
PAMT 194876390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100164130Medicaid
K006851Medicare PIN