Healthcare Provider Details

I. General information

NPI: 1013090141
Provider Name (Legal Business Name): DANIEL DAVID NAHUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 BLAZER PKWY
LEXINGTON KY
40509-1200
US

IV. Provider business mailing address

2333 ALUMNI PARK PLZ SUITE 200
LEXINGTON KY
40517-4012
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6021
  • Fax:
Mailing address:
  • Phone: 859-257-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17441
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number17441
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: