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General NPI Number Information
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NPI Number | 1134514532
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Entity Type | Individual
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Provider Name | JEESHAN ALI FARIDI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/02/2015
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 4371 NEW SHEPHERDSVILLE RD
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City | BARDSTOWN
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State | KY
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Zip | 40004-8040
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Country | US
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Telephone | 502-348-5685
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 936
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City | LONDON
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State | KY
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Zip | 40743-0936
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Country | US
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Telephone | 606-330-7835
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2021-02615
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 58849
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License Number State | KY
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