Healthcare Provider Details

I. General information

NPI: 1003063959
Provider Name (Legal Business Name): MONEERA NUR HAQUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E MAXWELL ST STE 200
LEXINGTON KY
40508-2678
US

IV. Provider business mailing address

PO BOX 2393
SCOTTSBLUFF NE
69363-2393
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-3231
  • Fax: 859-257-9461
Mailing address:
  • Phone: 312-469-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number125055437
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number069323
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number31383
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC0126
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: