Provider Demographics
NPI:1073563219
Name:ASHLAND MEDICAL GROUP
Entity Type:Organization
Organization Name:ASHLAND MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:RIAD
Authorized Official - Last Name:ABUL-KHOUDOUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-833-5864
Mailing Address - Street 1:1061 KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1527
Mailing Address - Country:US
Mailing Address - Phone:606-833-5864
Mailing Address - Fax:606-833-9760
Practice Address - Street 1:1061 KENWOOD DR
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KY
Practice Address - Zip Code:41169-1527
Practice Address - Country:US
Practice Address - Phone:606-833-5864
Practice Address - Fax:606-833-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty