1437469343 NPI number — PAVAN BEJGUM M.D

Table of content: PAVAN BEJGUM M.D (NPI 1437469343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437469343 NPI number — PAVAN BEJGUM M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEJGUM
Provider First Name:
PAVAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437469343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1029 MEDICAL CENTER CIR STE 202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYFIELD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42066-1189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-247-7795
Provider Business Mailing Address Fax Number:
800-574-6540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 SOUTH 9TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAYFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42066-2208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-247-7795
Provider Business Practice Location Address Fax Number:
800-574-6540
Provider Enumeration Date:
10/13/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  52262 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 036.126543 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: K348400 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100167630 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".