Provider Demographics
NPI:1447623632
Name:WESTERN KENTUCKY MEDICAL ASSOCIATES PSC
Entity type:Organization
Organization Name:WESTERN KENTUCKY MEDICAL ASSOCIATES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAZIMUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-782-0151
Mailing Address - Street 1:825 2ND AVE
Mailing Address - Street 2:SUITE B1
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1786
Mailing Address - Country:US
Mailing Address - Phone:270-782-0151
Mailing Address - Fax:270-782-7528
Practice Address - Street 1:825 2ND AVE
Practice Address - Street 2:SUITE B1
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1786
Practice Address - Country:US
Practice Address - Phone:270-782-0151
Practice Address - Fax:270-782-7528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty