Provider Demographics
NPI:1285785816
Name:WESTERN KY RHEUMATOLOGY, PLLC
Entity type:Organization
Organization Name:WESTERN KY RHEUMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KISHORKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-885-3876
Mailing Address - Street 1:PO BOX 4300
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-1148
Mailing Address - Country:US
Mailing Address - Phone:270-885-3876
Mailing Address - Fax:270-885-6349
Practice Address - Street 1:1830 HIGH ST STE A
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1746
Practice Address - Country:US
Practice Address - Phone:270-885-3876
Practice Address - Fax:270-885-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38463207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64081128Medicaid
TNDF6061Medicare PIN
KY9237Medicare PIN
TN3725186Medicare PIN
KYI08431Medicare UPIN
KYDB9391Medicare PIN