Provider Demographics
NPI:1215955042
Name:QURESHI, MUHAMMAD (MD)
Entity type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:
Last Name:QURESHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3273 MANTILLA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1160
Mailing Address - Country:US
Mailing Address - Phone:330-864-8900
Mailing Address - Fax:330-869-8924
Practice Address - Street 1:330 ROLAND AVE
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-1502
Practice Address - Country:US
Practice Address - Phone:859-335-9041
Practice Address - Fax:859-335-9072
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29123207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50005480OtherPASSPORT
KY000000274029OtherANTHEM
KY64063522Medicaid
KYP00041624OtherRR-MEDICARE
KY50005480OtherPASSPORT
KYF43545Medicare UPIN