Healthcare Provider Details

I. General information

NPI: 1720608169
Provider Name (Legal Business Name): HASEEB MOHIDEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD STE C305
LEXINGTON KY
40504-3771
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-8400
  • Fax: 859-276-3700
Mailing address:
  • Phone: 606-330-7835
  • Fax: 859-276-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number62102
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: