Provider Demographics
NPI:1598795833
Name:KABIR, MOHAMMED HUMAYUN (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:HUMAYUN
Last Name:KABIR
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 1:486 S FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-2382
Mailing Address - Country:US
Mailing Address - Phone:423-784-1197
Mailing Address - Fax:423-784-1123
Practice Address - Street 1:486 S FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-2382
Practice Address - Country:US
Practice Address - Phone:423-784-1197
Practice Address - Fax:423-784-1123
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000026093207RP1001X, 207RC0200X, 207R00000X
KY43944207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN0103Medicaid
TN4160871Medicaid
KY64920614Medicaid
TN100021371Medicaid
TN3072339OtherBCBST
TN3072339Medicaid
TN4160871OtherBCBS
TNTN0103Medicaid
TN4160871OtherBCBS
TN30887502Medicare PIN
TNTN0103Medicaid