Provider Demographics
NPI:1790996080
Name:ABDUL-WAHEED, MOHAMMAD (MD, MPH, MBBS)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:
Last Name:ABDUL-WAHEED
Suffix:
Gender:M
Credentials:MD, MPH, MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 2ND AVE
Mailing Address - Street 2:STE. B1
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1786
Mailing Address - Country:US
Mailing Address - Phone:270-782-0151
Mailing Address - Fax:270-782-7528
Practice Address - Street 1:825 2ND AVE
Practice Address - Street 2:STE. B1
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1786
Practice Address - Country:US
Practice Address - Phone:270-782-0151
Practice Address - Fax:270-782-7528
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57012257207RC0000X
KY44091207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100166850Medicaid