Healthcare Provider Details

I. General information

NPI: 1093166332
Provider Name (Legal Business Name): MOHAMMED ATHAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2016
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 KENOVA TRCE
LEXINGTON KY
40511-8856
US

IV. Provider business mailing address

720 KENOVA TRCE
LEXINGTON KY
40511-8856
US

V. Phone/Fax

Practice location:
  • Phone: 847-863-5412
  • Fax: 949-864-3136
Mailing address:
  • Phone: 847-863-5412
  • Fax: 949-864-3136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number60330
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number60330
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: