Provider Demographics
NPI:1912960774
Name:IDREES, MUHAMMAD ADNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MUHAMMAD
Middle Name:ADNAN
Last Name:IDREES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1595
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1595
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:606-408-6612
Practice Address - Street 1:10650 US ROUTE 60
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-9611
Practice Address - Country:US
Practice Address - Phone:606-408-7337
Practice Address - Fax:606-408-7798
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38632208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64095805Medicaid
KY64095805Medicaid
KY183440Medicare ID - Type Unspecified