Basic Information
Provider Information
NPI: 1003000902
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LOHANO
FirstName: JAIVANTI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2215 PORTLAND AVE
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 402121033
CountryCode: US
TelephoneNumber: 5027748631
FaxNumber: 5027783499
Practice Location
Address1: 2215 PORTLAND AVE
Address2:  
City: LOUISVILLE
State: KY
PostalCode: 402121033
CountryCode: US
TelephoneNumber: 5027748631
FaxNumber: 5027783499
Other Information
ProviderEnumerationDate: 09/04/2007
LastUpdateDate: 02/22/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X41402KYY Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000X01063381AINN Allopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
710006592005KY MEDICAID


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