Provider Demographics
NPI:1073367603
Name:KPA LLC
Entity Type:Organization
Organization Name:KPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NAWAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-964-3277
Mailing Address - Street 1:218 KEENE MANOR CIR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-7911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:218 KEENE MANOR CIR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-7911
Practice Address - Country:US
Practice Address - Phone:718-961-3277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center