Healthcare Provider Details

I. General information

NPI: 1003003351
Provider Name (Legal Business Name): MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15103 CHESTNUT RIDGE CIR
LOUISVILLE KY
40245-5291
US

IV. Provider business mailing address

PO BOX 890853
CHARLOTTE NC
28289-0853
US

V. Phone/Fax

Practice location:
  • Phone: 502-742-9149
  • Fax: 502-896-7292
Mailing address:
  • Phone: 800-605-5176
  • Fax: 937-298-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JAWED NASIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 502-742-9149