Individual
MIAN MUSHTAQ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 GORDON GUTMANN BLVD, STE 301, JEFFERSONVILLE, IN 47130-3764
(812) 288-9969
(812) 288-9657
Mailing address
315 E BROADWAY, LOUISVILLE, KY 40202-3700
(502) 629-2500
(502) 629-2055
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
01047786A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200437800
—
IN
05
—
64053093
—
KY
Enumeration date
05/26/2006
Last updated
01/20/2021
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