Provider Demographics
NPI:1578189510
Name:KC MUNFORD FAMILY CARE
Entity type:Organization
Organization Name:KC MUNFORD FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-268-7775
Mailing Address - Street 1:48 CEDARS RD
Mailing Address - Street 2:
Mailing Address - City:MUNFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36268-7191
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48 CEDARS RD
Practice Address - Street 2:
Practice Address - City:MUNFORD
Practice Address - State:AL
Practice Address - Zip Code:36268-7191
Practice Address - Country:US
Practice Address - Phone:256-268-7775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty