Healthcare Provider Details

I. General information

NPI: 1124028006
Provider Name (Legal Business Name): NISARFATHIMA KAZIMUDDIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NISARFATHIMA ABDULWAHEED MD

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 04/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 US 31W BYPASS
BOWLING GREEN KY
42101
US

IV. Provider business mailing address

421 US 31W BYPASS
BOWLING GREEN KY
42101
US

V. Phone/Fax

Practice location:
  • Phone: 270-785-0151
  • Fax: 270-715-4722
Mailing address:
  • Phone: 270-785-0151
  • Fax: 270-715-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number36859
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: