Provider Demographics
NPI:1104231067
Name:KAMAL, PALWASHA (MD)
Entity type:Individual
Prefix:DR
First Name:PALWASHA
Middle Name:
Last Name:KAMAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-587-6010
Mailing Address - Fax:
Practice Address - Street 1:6400 DUTCHMANS PKWY STE 345
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3370
Practice Address - Country:US
Practice Address - Phone:502-587-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-08458207R00000X
IN01082421A207R00000X, 207RE0101X
OH57.029092207RE0101X
KY59609207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01082421AOtherSTATE LICENSE
IN300035195Medicaid
KY7100887010Medicaid