Healthcare Provider Details

I. General information

NPI: 1588719868
Provider Name (Legal Business Name): MOHEN BOHJWANI MD, LFAPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MOHAN BHOJWANI M.D.

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 JOLIET ST
DYER IN
46311-1705
US

IV. Provider business mailing address

1121 WHEATFIELD CT
DAYTON OH
45458-4742
US

V. Phone/Fax

Practice location:
  • Phone: 219-864-2232
  • Fax:
Mailing address:
  • Phone: 937-689-0290
  • Fax: 937-689-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number24864
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101037264
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35053201
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-035286-E
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01034729A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: