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General NPI Number Information
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NPI Number | 1962654178
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Entity Type | Organization
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Legal Business Name | BLUEGRASS MEDICINE & NEPHROLOGY, LLC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 06/29/2009
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Provider Practice Location Address
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Address Line | 455 LEWIS AVE SUITE 214
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City | MERIDEN
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State | CT
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Zip | 06451-2121
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Country | US
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Telephone | 203-237-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 455 LEWIS AVE SUITE 214
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City | MERIDEN
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State | CT
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Zip | 06451-2121
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Country | US
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Telephone | 203-237-6700
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | IRFAN SAEED CHUGHTAI
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Credential | M.D.
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Telephone | 203-237-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 039668
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License Number State | CT
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