Healthcare Provider Details

I. General information

NPI: 1881692861
Provider Name (Legal Business Name): WESTERN KENTUCKY HEART & LUNG ASSOCIATES PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/21/2022
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 US 31W BYP
BOWLING GREEN KY
42101-1775
US

IV. Provider business mailing address

421 US 31W BYP
BOWLING GREEN KY
42101-1775
US

V. Phone/Fax

Practice location:
  • Phone: 270-782-0251
  • Fax: 270-782-7528
Mailing address:
  • Phone: 270-782-0251
  • Fax: 270-782-7528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED KAZIMUDDIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 270-782-0151