Provider Demographics
NPI:1205128717
Name:KIDNEY SPECIALIST OF KENTUCKY PLLC
Entity type:Organization
Organization Name:KIDNEY SPECIALIST OF KENTUCKY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHALID
Authorized Official - Middle Name:SPECIALIST OF
Authorized Official - Last Name:BHATTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-765-5112
Mailing Address - Street 1:500 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1738
Mailing Address - Country:US
Mailing Address - Phone:270-904-2050
Mailing Address - Fax:270-904-4117
Practice Address - Street 1:500 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1738
Practice Address - Country:US
Practice Address - Phone:270-904-2050
Practice Address - Fax:270-904-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100162080Medicaid
KY7100162080Medicaid