Provider Demographics
NPI:1689019440
Name:BLUEGRASS MEDICAL PRACTITIONERS INC.
Entity Type:Organization
Organization Name:BLUEGRASS MEDICAL PRACTITIONERS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MITTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-757-4353
Mailing Address - Street 1:47 CAVALIER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-3970
Mailing Address - Country:US
Mailing Address - Phone:859-757-4353
Mailing Address - Fax:859-534-0865
Practice Address - Street 1:47 CAVALIER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3970
Practice Address - Country:US
Practice Address - Phone:859-757-4353
Practice Address - Fax:859-534-0865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty