Organization
PAIN MANAGEMENT MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANESH MAZLOOMDOOST M.D. (PRESIDENT)
(859) 275-4878
Entity
Organization
Contact information
Practice address
715 SHAKER DR, SUITE 132, LEXINGTON, KY 40504-3662
(859) 275-4878
Mailing address
725 SHAKER DRIV, SUITE 132, LEXINGTON, KY 40504
(859) 278-4878
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
TC537
KY
Other
Enumeration date
10/07/2016
Last updated
10/07/2016
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