Healthcare Provider Details

I. General information

NPI: 1265498745
Provider Name (Legal Business Name): MANSHA U KAHLOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MANSHA ULLAH MD

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 FLEMINGSBURG RD
MOREHEAD KY
40351-1015
US

IV. Provider business mailing address

245 FLEMINGSBURG RD
MOREHEAD KY
40351-1015
US

V. Phone/Fax

Practice location:
  • Phone: 606-780-5500
  • Fax: 606-780-5512
Mailing address:
  • Phone: 606-780-5500
  • Fax: 606-780-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number37690
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number37690
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: