Individual
PRADEEP S MOHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4200 GREEN VALLEY RD, CIBOLO, TX 78108-1900
(325) 665-9111
Mailing address
4200 GREEN VALLEY RD, CIBOLO, TX 78108-1900
(325) 665-9111
Taxonomy
Speciality
Code
Description
License number
State
2086S0105X
Surgery of the Hand (Surgery) Physician
036116392
IL
2086S0105X
Surgery of the Hand (Surgery) Physician
N8956
TX
2086S0122X
Plastic and Reconstructive Surgery Physician
036116392
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
N8956
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200922110
—
IN
01
—
3581444000
PASSPORT ADVANTAGE
KY
01
—
50021605
PASSPORT
KY
05
—
7100067840
—
KY
Enumeration date
05/03/2007
Last updated
04/23/2017
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