Provider Demographics
NPI:1548362098
Name:MOHAN, PRABHA (MD)
Entity type:Individual
Prefix:DR
First Name:PRABHA
Middle Name:
Last Name:MOHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:PRABHA
Other - Middle Name:
Other - Last Name:SHRIVASTAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:709 W HIGHWAY 243
Mailing Address - Street 2:SUITE-C
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-1860
Mailing Address - Country:US
Mailing Address - Phone:972-932-2000
Mailing Address - Fax:972-932-0316
Practice Address - Street 1:709 W HIGHWAY 243
Practice Address - Street 2:SUITE-C
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1860
Practice Address - Country:US
Practice Address - Phone:972-932-2000
Practice Address - Fax:972-932-0316
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1567207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF79107Medicare UPIN
TX0018AVMedicare ID - Type Unspecified