Provider Demographics
NPI:1811902570
Name:MIDWEST INTERNAL MEDICINE P.S.C
Entity type:Organization
Organization Name:MIDWEST INTERNAL MEDICINE P.S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MS
Authorized Official - First Name:NUZHAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-568-6722
Mailing Address - Street 1:250 E LIBERTY ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1534
Mailing Address - Country:US
Mailing Address - Phone:502-568-6722
Mailing Address - Fax:502-568-6733
Practice Address - Street 1:250 E LIBERTY ST STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1534
Practice Address - Country:US
Practice Address - Phone:502-568-6722
Practice Address - Fax:502-568-6733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64016033Medicaid
KYDA0912OtherRAILROAD MEDICARE GROUP
KY64016033Medicaid