Provider Demographics
NPI:1609830462
Name:SHAHZAD, MOHAMMAD FATEH (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:FATEH
Last Name:SHAHZAD
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 1:105 PONDER CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9050
Mailing Address - Country:US
Mailing Address - Phone:859-236-4216
Mailing Address - Fax:859-238-9760
Practice Address - Street 1:105 PONDER CT
Practice Address - Street 2:SUITE 104
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-9050
Practice Address - Country:US
Practice Address - Phone:859-236-4216
Practice Address - Fax:859-238-9760
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33429207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64332497Medicaid
KY64332497Medicaid
0619603Medicare PIN