Provider Demographics
NPI:1003003351
Name:MEDICINE PLLC
Entity Type:Organization
Organization Name:MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAWED
Authorized Official - Middle Name:
Authorized Official - Last Name:NASIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-742-9149
Mailing Address - Street 1:PO BOX 890853
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0853
Mailing Address - Country:US
Mailing Address - Phone:800-605-5176
Mailing Address - Fax:937-298-5596
Practice Address - Street 1:15103 CHESTNUT RIDGE CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5291
Practice Address - Country:US
Practice Address - Phone:502-742-9149
Practice Address - Fax:502-896-7292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6435287500Medicaid
IN200906410AMedicaid
KY6435287500Medicaid
IN200906410AMedicaid
KY00495Medicare PIN