Provider Demographics
NPI:1821020934
Name:WEST KENTUCKY NEUROLOGICAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:WEST KENTUCKY NEUROLOGICAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SINGLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-885-5003
Mailing Address - Street 1:1721 CANTON ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1925
Mailing Address - Country:US
Mailing Address - Phone:270-885-5003
Mailing Address - Fax:270-885-5826
Practice Address - Street 1:1721 CANTON ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1925
Practice Address - Country:US
Practice Address - Phone:270-885-5003
Practice Address - Fax:270-885-5826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN
7182Medicare ID - Type Unspecified