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Organization

PEDIATRIC CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. HOUSHANG KHORRAM MD (DOCTOR)
(606) 248-8282
Entity
Organization

Contact information

Practice address
3604 CUMBERLAND AVE, MIDDLESBORO, KY 40965-2614
(606) 248-8282
(606) 248-0030
Mailing address
3604 WEST CUMBERLAND AVENUE, MIDDLESBORO, KY 40965
(606) 248-8282
(606) 248-0030

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
164526
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
005628491
VA
05
0095596
TN
05
16526
KY
Enumeration date
10/15/2012
Last updated
10/15/2012
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