Provider Demographics
NPI:1891766101
Name:ALAM, RAFIQUL (MD)
Entity Type:Individual
Prefix:
First Name:RAFIQUL
Middle Name:
Last Name:ALAM
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 1:172 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1786
Mailing Address - Country:US
Mailing Address - Phone:606-433-9905
Mailing Address - Fax:606-432-3890
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:STE 2K
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9466
Practice Address - Country:US
Practice Address - Phone:606-487-8063
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33327174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64333271Medicaid
KYG13209Medicare UPIN
KY64333271Medicaid