Healthcare Provider Details

I. General information

NPI: 1518046994
Provider Name (Legal Business Name): MANSOOR MAHMOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MANSOOR MAHMOOD MD

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 PHILLIPS BRANCH RD BOX 1085
PHELPS KY
41553-9061
US

IV. Provider business mailing address

PO BOX 144
FOREST HILLS KY
41527-0144
US

V. Phone/Fax

Practice location:
  • Phone: 606-456-3477
  • Fax: 606-456-8246
Mailing address:
  • Phone: 606-456-3477
  • Fax: 606-456-8246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31447
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: