Healthcare Provider Details

I. General information

NPI: 1619148012
Provider Name (Legal Business Name): ELIZABETHTOWN RHEUMATOLOGY PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 N DIXIE AVE STE 206
ELIZABETHTOWN KY
42701-2541
US

IV. Provider business mailing address

914 N DIXIE AVE STE 206
ELIZABETHTOWN KY
42701-2541
US

V. Phone/Fax

Practice location:
  • Phone: 270-737-7021
  • Fax: 270-982-5138
Mailing address:
  • Phone: 270-982-5138
  • Fax: 270-982-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number36225
License Number StateKY

VIII. Authorized Official

Name: SALEEM SAJID
Title or Position: OWNER
Credential: MD
Phone: 270-982-5138