MEDICARE: MANEESH K MEHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	093450	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386751949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANEESH K MEHAN M.D.

Provider Business Mailing Address
First Line	:	1020 WOODMAN DR
Second Line	:	SUITE 200
City	:	DAYTON
State	:	OH
Zip	:	45432-1446
Country	:	US
Telephone Number	:	937-258-4570
Fax Number	:	937-258-4573

Provider Business Practice Location Address
First Line	:	1020 WOODMAN DR
Second Line	:	SUITE 200
City	:	DAYTON
State	:	OH
Zip	:	45432-1446
Country	:	US
Telephone Number	:	937-258-4570
Fax Number	:	937-258-4573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	02/10/2010

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