Provider Demographics
NPI:1750476842
Name:PIKEVILLE CARDIOLOGY CLINIC
Entity Type:Organization
Organization Name:PIKEVILLE CARDIOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-432-4104
Mailing Address - Street 1:255 CHURCH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3476
Mailing Address - Country:US
Mailing Address - Phone:606-431-4104
Mailing Address - Fax:606-432-6817
Practice Address - Street 1:255 CHURCH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3476
Practice Address - Country:US
Practice Address - Phone:606-431-4104
Practice Address - Fax:606-432-6817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7799Medicare ID - Type Unspecified