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NPI Code Detail

MEDICARE: MOHAMMAD FATTAL MD

MEDICARE: MOHAMMAD FATTAL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician43438KY

General Provider Information

NPI Number : 1114194156
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOHAMMAD FATTAL MD
Provider Business Mailing Address
First Line : PO BOX 6716
Second Line :
City : FLORENCE
State : KY
Zip : 41022-6716
Country : US
Telephone Number : 859-342-4087
Fax Number :
Provider Business Practice Location Address
First Line : 3876 TURKEYFOOT RD
Second Line :
City : ELSMERE
State : KY
Zip : 41018-2838
Country : US
Telephone Number : 859-342-8775
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2008
Last Update Date : 01/08/2024

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