Healthcare Provider Details

I. General information

NPI: 1245459353
Provider Name (Legal Business Name): LUNG DISEASE SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 W WALNUT ST SUITE 201
DANVILLE KY
40422-1852
US

IV. Provider business mailing address

439 W WALNUT ST SUITE 201
DANVILLE KY
40422-1852
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-9203
  • Fax: 859-236-6754
Mailing address:
  • Phone: 859-236-9203
  • Fax: 859-236-6754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number33677
License Number StateKY

VIII. Authorized Official

Name: DR. WASEEM AHMED
Title or Position: PRESIDENT
Credential: MD
Phone: 859-236-9203