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MANOOCHER MOFIDI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2225 W BROADWAY, LOUISVILLE, KY 40211-1003
(502) 589-8600
(502) 589-8771
Mailing address
101 W MUHAMMAD ALI BLVD, LOUISVILLE, KY 40202-1423

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01037544A
IN
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
25630
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200189820A
IN
Enumeration date
07/16/2006
Last updated
02/13/2013
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