Healthcare Provider Details

I. General information

NPI: 1073592572
Provider Name (Legal Business Name): HEART CENTER OF SOMERSET PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 HARDIN LN SUITE B
SOMERSET KY
42503-3800
US

IV. Provider business mailing address

104 HARDIN LN SUITE B
SOMERSET KY
42503-3800
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-1112
  • Fax: 606-679-1341
Mailing address:
  • Phone: 606-677-1112
  • Fax: 606-679-1341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: IBRAIZ IQBAL
Title or Position: PHYSICIAN
Credential: MD
Phone: 606-677-1112