Provider Demographics
NPI:1053310409
Name:KAZIMUDDIN, MOHAMMED (MD FACC FSCAI)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:
Last Name:KAZIMUDDIN
Suffix:
Gender:M
Credentials:MD FACC FSCAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 SECOND AVE
Mailing Address - Street 2:STE B1
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101
Mailing Address - Country:US
Mailing Address - Phone:270-782-0151
Mailing Address - Fax:270-782-7528
Practice Address - Street 1:825 SECOND AVE
Practice Address - Street 2:STE B1
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:270-782-0151
Practice Address - Fax:270-782-7528
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36951207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64044613Medicaid
KY697001Medicare PIN
KYG14303Medicare UPIN