Organization
CENTRAL KENTUCKY INTERVENTIONAL PAIN CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHURSHEED SIDDIQUI MD (OWNER/GROUP PRESIDENT)
(859) 236-0606
Entity
Organization
Contact information
Practice address
300 W BROADWAY ST, DANVILLE, KY 40422-1408
(859) 236-0606
(859) 236-0066
Mailing address
PO BOX 7096, STOCKTON, CA 95267-0096
(209) 956-7725
(209) 956-7733
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
28741
KY
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208VP0000X
Pain Medicine Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65942906
—
KY
Enumeration date
07/18/2005
Last updated
12/28/2017
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