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NPI Code Detail

MEDICARE: DR. MAHAN GHIASSI M.D.

MEDICARE: DR. MAHAN GHIASSI 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
1207T00000XNeurological Surgery PhysicianE-8572AR
2207T00000XNeurological Surgery Physician49962KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2K250170OTHERKYMEDICARE KENTUCKY

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 : 1285827725
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAHAN GHIASSI M.D.
Provider Business Mailing Address
First Line : PO BOX 776351
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6351
Country : US
Telephone Number : 502-588-9490
Fax Number :
Provider Business Practice Location Address
First Line : 4915 NORTON HEALTHCARE BLVD STE 301
Second Line :
City : LOUISVILLE
State : KY
Zip : 40241-2866
Country : US
Telephone Number : 502-394-6390
Fax Number : 502-394-6388
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2007
Last Update Date : 05/01/2025

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