Provider Demographics
NPI:1114919404
Name:QADIR, EHSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EHSAN
Middle Name:
Last Name:QADIR
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 1:910 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-2414
Mailing Address - Country:US
Mailing Address - Phone:270-259-1656
Mailing Address - Fax:270-259-9536
Practice Address - Street 1:910 WALLACE AVE.
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-2414
Practice Address - Country:US
Practice Address - Phone:270-259-1656
Practice Address - Fax:270-259-9536
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33703207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00104258OtherRAILROAD MEDICARE
KYP00145372OtherRAILROAD MEDICARE
KY000000313491OtherANTHEM
KY000000312389OtherANTHEM
KY64337033Medicaid
0792801Medicare ID - Type Unspecified
KY000000312389OtherANTHEM
KYG85524Medicare UPIN