Provider Demographics
NPI:1114900016
Name:UDDIN, FAIZ M (MD)
Entity Type:Individual
Prefix:DR
First Name:FAIZ
Middle Name:M
Last Name:UDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MARY LEE ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4481
Mailing Address - Country:US
Mailing Address - Phone:859-539-9905
Mailing Address - Fax:
Practice Address - Street 1:800 W LINCOLN TRAIL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2671
Practice Address - Country:US
Practice Address - Phone:270-351-3515
Practice Address - Fax:270-351-7506
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY38224207Q00000X
IL036110727207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64066764Medicaid
KY00546037Medicare UPIN