Healthcare Provider Details

I. General information

NPI: 1043291081
Provider Name (Legal Business Name): KHURRAM NAZEER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 EAST GRAY SUITE 858
LOUISVILLE KY
40202-1715
US

IV. Provider business mailing address

234 E GRAY ST SUITE 858
LOUISVILLE KY
40202-1900
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-1799
  • Fax: 502-583-1792
Mailing address:
  • Phone: 502-583-1799
  • Fax: 502-583-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number38902
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: