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NPI Code Detail

MEDICARE: MOHAN PRABU M.D.

MEDICARE: MOHAN PRABU M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician01072686AIN
22084N0400XNeurology Physician27885NE
32084N0400XNeurology PhysicianME149732FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104021062
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOHAN PRABU M.D.
Provider Business Mailing Address
First Line : 2354 W BOULEVARD
Second Line :
City : KOKOMO
State : IN
Zip : 46902-6069
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2354 W BOULEVARD
Second Line :
City : KOKOMO
State : IN
Zip : 46902-6069
Country : US
Telephone Number : 765-457-4800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2007
Last Update Date : 08/09/2022

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