Provider Demographics
NPI:1992779128
Name:KAVARANA, MINOO N (MD)
Entity type:Individual
Prefix:
First Name:MINOO
Middle Name:N
Last Name:KAVARANA
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:PO BOX 751461
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1461
Mailing Address - Country:US
Mailing Address - Phone:843-792-6200
Mailing Address - Fax:
Practice Address - Street 1:171 ASHLEY AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-0100
Practice Address - Country:US
Practice Address - Phone:843-792-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37044208G00000X
SC329732086S0120X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000377926OtherANTHEM PROVIDER #
KY61-1427889OtherHUMANA
KY61-1427889OtherTRICARE
KYP00333912OtherRRMCR
KY030670000OtherBLACK LUNG
KY50006567OtherPASSPORT HEALTH PLAN
KY64099567Medicaid
KY61-1427889OtherBLUEGRASS FAMILY HEALTH
KY61-1427889OtherCHA
KY61-1427889OtherUHC
KYC40884OtherCUMBERLAND HEALTHCARE INC
KY64099567Medicaid
KY000000377926OtherANTHEM PROVIDER #