# CENTRAL KENTUCKY INTERVENTIONAL PAIN CENTER, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407855935
- **Authorized official:** KHURSHEED SIDDIQUI MD (OWNER/GROUP PRESIDENT)
- **Authorized official phone:** (859) 236-0606

## Contact information

- **Practice address:** 300 W BROADWAY ST, DANVILLE, KY 40422-1408
- **Practice address phone:** (859) 236-0606
- **Practice address fax:** (859) 236-0066
- **Mailing address:** PO BOX 7096, STOCKTON, CA 95267-0096
- **Mailing address phone:** (209) 956-7725
- **Mailing address fax:** (209) 956-7733

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 28741 | KY | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 208VP0000X | Pain Medicine Physician | — | NULL | Yes |
| 208VP0000X | Pain Medicine Physician | — | — | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 07/18/2005
- **Last updated:** 12/28/2017