Healthcare Provider Details

I. General information

NPI: 1528401502
Provider Name (Legal Business Name): JOHONGIR M MURADOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 DANIEL DR
DANVILLE KY
40422-2527
US

IV. Provider business mailing address

PO BOX 990
DANVILLE KY
40423-0990
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-2222
  • Fax:
Mailing address:
  • Phone: 859-236-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number50347
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: