Provider Demographics
NPI:1740217157
Name:MOTALIB, MOHAMMAD ABDUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:ABDUL
Last Name:MOTALIB
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 1:830 SOUTH LIMESTONE STREET
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0001
Mailing Address - Country:US
Mailing Address - Phone:859-218-3206
Mailing Address - Fax:859-257-2625
Practice Address - Street 1:830 S LIMESTONE STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-2389
Practice Address - Country:US
Practice Address - Phone:859-218-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207P00000X207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64332240Medicaid
KY954353Medicare ID - Type UnspecifiedMKY
KY64332240Medicaid