Provider Demographics
NPI:1962654178
Name:BLUEGRASS MEDICINE & NEPHROLOGY, LLC
Entity Type:Organization
Organization Name:BLUEGRASS MEDICINE & NEPHROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:IRFAN
Authorized Official - Middle Name:SAEED
Authorized Official - Last Name:CHUGHTAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-237-6700
Mailing Address - Street 1:455 LEWIS AVE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06451-2121
Mailing Address - Country:US
Mailing Address - Phone:203-237-6700
Mailing Address - Fax:
Practice Address - Street 1:455 LEWIS AVE
Practice Address - Street 2:SUITE 214
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06451-2121
Practice Address - Country:US
Practice Address - Phone:203-237-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039668261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H72331Medicare UPIN