Provider Demographics
NPI:1639520497
Name:KANDEL, MUHAMMAD ABOLFOTOH (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:ABOLFOTOH
Last Name:KANDEL
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:MOHAMAD
Other - Middle Name:A
Other - Last Name:MOHAMAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:220 ABRAHAM FLEXNER WAY FL 15
Mailing Address - Street 2:DEPARTMENT OF NEUROSURGERY
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3826
Mailing Address - Country:US
Mailing Address - Phone:617-877-0369
Mailing Address - Fax:
Practice Address - Street 1:220 ABRAHAM FLEXNER WAY FL 15
Practice Address - Street 2:DEPARTMENT OF NEUROSURGERY
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3826
Practice Address - Country:US
Practice Address - Phone:617-877-0369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY390200000X
KYR4309207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1639520497OtherNPI NUMBER
KYR4309OtherKENTUCKY MEDICAL LICENSE