Provider Demographics
NPI:1609858539
Name:MAHMOOD, IJAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:IJAZ
Middle Name:
Last Name:MAHMOOD
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 1:1239 WOODLAND DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2770
Mailing Address - Country:US
Mailing Address - Phone:270-900-1461
Mailing Address - Fax:270-900-1468
Practice Address - Street 1:1239 WOODLAND DR
Practice Address - Street 2:SUITE 105
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2770
Practice Address - Country:US
Practice Address - Phone:270-900-1461
Practice Address - Fax:270-900-1468
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31150207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64311509Medicaid
KY1048927OtherPASSPORT
KYE63326Medicare UPIN
KY64311509Medicaid