Mofidi, Manoocher

Mofidi, Manoocher is an sole proprietor health care provider with primary practice located at 2225 W Broadway , Louisville KY 40211-1003. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry. Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry is his primary health care specialty. Mofidi, Manoocher can be contacted via phone (502) 589-8600.

Contact Information

Primary practice address
2225 W Broadway Louisville KY 40211-1003
Phone: (502) 589-8600
Fax: (502) 589-8771
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X 01037544A Indiana
Allopathic & Osteopathic Physicians / Child & Adolescent Psychiatry 2084P0804X 25630 Kentucky

Profile Details

NPI number 1013934959
LBN Legal business name Mofidi, Manoocher
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 16th, 2006
Last updated Feb 13th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013934959 NPPES
Indiana MEDICAID 200189820A

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