Provider Demographics
NPI:1083697205
Name:NASIR, MUJAHID A (MD)
Entity Type:Individual
Prefix:
First Name:MUJAHID
Middle Name:A
Last Name:NASIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1321 RING RD
Mailing Address - Street 2:STE 105
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8940
Mailing Address - Country:US
Mailing Address - Phone:270-986-7373
Mailing Address - Fax:270-900-4636
Practice Address - Street 1:1311 RING RD
Practice Address - Street 2:STE 101
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8941
Practice Address - Country:US
Practice Address - Phone:270-900-4555
Practice Address - Fax:270-900-4636
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2017-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY39436207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64105539Medicaid
KY64105539Medicaid
KYK024220Medicare PIN