Healthcare Provider Details

I. General information

NPI: 1932101771
Provider Name (Legal Business Name): ASAD K JADOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 CENTER DR
RICHMOND KY
40475-3838
US

IV. Provider business mailing address

1042 CENTER DR
RICHMOND KY
40475-3838
US

V. Phone/Fax

Practice location:
  • Phone: 859-625-1723
  • Fax: 859-625-5414
Mailing address:
  • Phone: 859-625-1723
  • Fax: 859-625-5414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number32580
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number32580
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: