Provider Demographics
NPI:1639223019
Name:NAWAB, SYED MEHDI (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:MEHDI
Last Name:NAWAB
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 1:10003 BROWNSBORO GARDENS CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-6116
Mailing Address - Country:US
Mailing Address - Phone:502-635-6321
Mailing Address - Fax:502-637-6386
Practice Address - Street 1:10003 BROWNSBORO GARDENS CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-6116
Practice Address - Country:US
Practice Address - Phone:502-635-6321
Practice Address - Fax:502-637-6386
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17247208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100057670Medicaid
KY7100057670Medicaid