Healthcare Provider Details

I. General information

NPI: 1003369752
Provider Name (Legal Business Name): PARISA SAMIMI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PARK ST
BOWLING GREEN KY
42101-1708
US

IV. Provider business mailing address

201 PARK ST
BOWLING GREEN KY
42101-1708
US

V. Phone/Fax

Practice location:
  • Phone: 270-783-0452
  • Fax: 270-780-0466
Mailing address:
  • Phone: 270-783-0452
  • Fax: 270-780-0466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberTP101
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number55372
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: