Individual
MITTRA ESMAEILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
398 DIEDERICH BLVD, ASHLAND, KY 41101-7008
(606) 324-8060
(606) 325-6889
Mailing address
PO BOX 1595, ASHLAND, KY 41105-1595
(606) 408-9571
(606) 408-6061
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
04945
KY
207Q00000X
Family Medicine Physician
58.007308
OH
207Q00000X
Family Medicine Physician
TP870
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0331450
—
OH
05
—
7100724840
—
KY
Enumeration date
10/27/2015
Last updated
05/20/2022
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