Healthcare Provider Details

I. General information

NPI: 1871576702
Provider Name (Legal Business Name): JAWED NASIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DUTCHMANS LN
LOUISVILLE KY
40207-4714
US

IV. Provider business mailing address

PO BOX 890853
CHARLOTTE NC
28289-0853
US

V. Phone/Fax

Practice location:
  • Phone: 502-380-5505
  • Fax: 502-426-8272
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 Number35287
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: