Provider Demographics
NPI:1942489083
Name:DANVILLE NEPHROLOGY CONSULTANTS
Entity Type:Organization
Organization Name:DANVILLE NEPHROLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARIQ
Authorized Official - Middle Name:
Authorized Official - Last Name:MUHAMMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-236-9203
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0368
Mailing Address - Country:US
Mailing Address - Phone:859-236-9203
Mailing Address - Fax:859-236-6754
Practice Address - Street 1:439 W WALNUT ST
Practice Address - Street 2:STE 201
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1852
Practice Address - Country:US
Practice Address - Phone:859-236-9203
Practice Address - Fax:859-236-6754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY30622207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCH6075OtherRAILROAD MCARE
KY64306228Medicaid
KY000000077435OtherANTHEM BCBS
KYCH6075OtherRAILROAD MCARE