Organization
DANVILLE INTERVENTIONAL PAIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KHURSHEED SIDDIQUI MD (PRESIDENT)
(859) 236-9203
Entity
Organization
Contact information
Practice address
300 WEST BROADWAY, DANVILLE, KY 40422
(859) 236-9203
(859) 236-6754
Mailing address
PO BOX 7096, STOCKTON, CA 95267
(209) 956-7725
(209) 956-7733
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65942906
—
KY
01
—
DD1588
RAILROAD MEDICARE
KY
Enumeration date
06/03/2006
Last updated
08/22/2020
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