Organization
CENTER FOR RECOVERY AND WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KHURSHEED A SIDDIQUI MD (OWNER)
(859) 691-0201
Entity
Organization
Contact information
Practice address
300 W BROADWAY ST, DANVILLE, KY 40422
(859) 236-0606
(859) 236-0066
Mailing address
300 W BROADWAY ST, DANVILLE, KY 40422-1408
(859) 236-0606
(859) 236-0066
Taxonomy
Speciality
Code
Description
License number
State
207LA0401X
Addiction Medicine (Anesthesiology) Physician
Primary
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100418720
—
KY
Enumeration date
05/12/2016
Last updated
02/27/2020
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