Individual
DR. MAHAN GHIASSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4915 NORTON HEALTHCARE BLVD STE 301, LOUISVILLE, KY 40241-2866
(502) 394-6390
(502) 394-6388
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
49962
KY
207T00000X
Neurological Surgery Physician
E-8572
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100490440
—
KY
01
—
K250170
MEDICARE KENTUCKY
KY
Enumeration date
08/18/2007
Last updated
05/01/2025
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