Provider Demographics
NPI:1336151943
Name:KAMAL MOULANA MD PSC
Entity Type:Organization
Organization Name:KAMAL MOULANA MD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOULANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-769-9881
Mailing Address - Street 1:1240 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2767
Mailing Address - Country:US
Mailing Address - Phone:270-769-9881
Mailing Address - Fax:270-769-9589
Practice Address - Street 1:1240 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2767
Practice Address - Country:US
Practice Address - Phone:270-769-9881
Practice Address - Fax:270-769-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31778207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64999840Medicaid
0328101Medicare PIN
KYF73827Medicare UPIN