Provider Demographics
NPI:1639238629
Name:K MAHMOOD M D INC
Entity Type:Organization
Organization Name:K MAHMOOD M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-353-1819
Mailing Address - Street 1:960 W WOOSTER ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2644
Mailing Address - Country:US
Mailing Address - Phone:419-353-1819
Mailing Address - Fax:419-353-8364
Practice Address - Street 1:960 W WOOSTER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2644
Practice Address - Country:US
Practice Address - Phone:419-353-1819
Practice Address - Fax:419-353-8364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDN7869OtherRAILROAD MEDICARE
OH2849798Medicaid
OH0784671Medicare PIN