Healthcare Provider Details

I. General information

NPI: 1386665040
Provider Name (Legal Business Name): MOHAN J.S. BRAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3439
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-287-3045
  • Fax: 859-578-3800
Mailing address:
  • Phone: 859-341-3015
  • Fax: 859-301-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number36507
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: