Individual ProviderMittra EsmaeiliFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address398 Diederich Blvd, Ashland, KY 41101-7008(606) 324-8060(606) 408-9571PECOS EnrollmentBased on the most recent information from CMS, provider Mittra Esmaeili is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 8 days ago.Profile DetailsProvider ID1114399474Provider TypeIndividualFull NameEsmaeili, MittraCredentialD.O.GenderFemaleSole ProprietorYesEnumeration Date10/27/2015Last Updated5/20/2022Contact InformationPractice LocationPractice Address398 Diederich Blvd, Ashland, KY 41101-7008Phone(606) 324-8060Fax(606) 325-6889Mailing LocationMailing AddressPO Box 1595, Ashland, KY 41105-1595Phone(606) 408-9571Fax(606) 408-6061Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense04945KentuckyCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense58.007308OhioCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseTP870KentuckyProvider IdentifiersIDDescriptionIssuerID7100724840DescriptionMedicaidIssuerUnlistedKentuckyID0331450DescriptionMedicaidIssuerUnlistedOhio