Healthcare Provider Details

I. General information

NPI: 1558361550
Provider Name (Legal Business Name): RICHMOND NEPHROLOGY & HYPERTENSION PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 CENTER DRIVE, SUITE A
RICHMOND KY
40475-3838
US

IV. Provider business mailing address

1036 CENTER DRIVE, SUITE A
RICHMOND KY
40475-3838
US

V. Phone/Fax

Practice location:
  • Phone: 859-626-1700
  • Fax: 859-626-1702
Mailing address:
  • Phone: 859-626-1700
  • Fax: 859-626-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number173647
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number34262
License Number StateKY

VIII. Authorized Official

Name: RIZWAN AKHTAR
Title or Position: OFFICE MANAGER
Credential: M.D.
Phone: 859-626-1700