Provider Demographics
NPI:1134117690
Name:BADEM, KECIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KECIA
Middle Name:
Last Name:BADEM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2454
Mailing Address - Country:US
Mailing Address - Phone:615-867-8010
Mailing Address - Fax:615-867-8019
Practice Address - Street 1:1004 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2454
Practice Address - Country:US
Practice Address - Phone:615-867-8010
Practice Address - Fax:615-867-8019
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3825974Medicare ID - Type Unspecified
TNG75872Medicare UPIN