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General NPI Number Information
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NPI Number | 1619325719
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Entity Type | Organization
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Legal Business Name | BLUEGRASS VASCULAR INSTITUTE
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 101 FINANCIAL DR SUITE B103
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701
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Country | US
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Telephone | 502-203-0300
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Fax | 270-569-0000
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Provider Business Mailing Address
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Address Line | 101 FINANCIAL DR SUITE B103
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701
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Country | US
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Telephone | 770-910-2377
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MIRZA AHMED
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Credential | M.D
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Telephone | 404-775-3232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 034761
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License Number State | GA
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