Healthcare Provider Details

I. General information

NPI: 1477505634
Provider Name (Legal Business Name): YASSER A NADIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 TRADEPARK DR STE B
SOMERSET KY
42503-3427
US

IV. Provider business mailing address

118 TRADEPARK DR ST B
SOMERSET KY
42503-3427
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-7464
  • Fax: 606-678-8586
Mailing address:
  • Phone: 606-679-7464
  • Fax: 606-678-8586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number34018
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34018
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: