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General NPI Number Information
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NPI Number | 1639399249
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Entity Type | Organization
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Legal Business Name | MOHAMMAD A. MIAN, MD PSC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 9017 TAYLORSVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40299-1749
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Country | US
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Telephone | 502-499-9993
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Fax | 502-495-0758
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Provider Business Mailing Address
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Address Line | 9017 TAYLORSVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40299-1749
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Country | US
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Telephone | 502-499-9993
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Fax | 502-495-0758
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JACQUELINE JACOBS SINGER
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Credential |
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Telephone | 502-499-9993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 425
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22242
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License Number State | KY
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