Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 036136723 | IL |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 04-36621 | KS |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2014036782 | MO |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | MD-43470 | IA |
N | 2081P2900X | Pain Medicine | 036136723 | IL |
NPI | 1417269655 |
---|---|
Provider Name | Dr. Mahesh Mohan |
First Address | Waterloo, IA 50702 |
Second Address | Waterloo, IA 50702-5634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2010 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201072640A | (05) | KS |