Individual
MR. MAHENDRA C MARU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1930 E PARRISH AVE, OWENSBORO, KY 42303-1443
(270) 689-1919
(270) 689-1990
Mailing address
1930 E PARRISH AVE, OWENSBORO, KY 42303-1443
(270) 689-1919
(270) 689-1990
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
33042
KY
207RN0300X
Nephrology Physician
Primary
33042
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000067006
ANTHEM PIN
IN
01
—
000000067006
ANTHEM
KY
05
—
200145790
—
IN
05
—
64330426
—
KY
01
—
CJ7612
RAILROAD MEDICARE
IN
01
—
CJ7612
RAILROAD MEDICARE
KY
Enumeration date
07/05/2005
Last updated
06/23/2015
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