Provider Demographics
NPI:1023072097
Name:ENLOW AND SHAHZAD ASSOCIATES IN MEDICINE,PSC
Entity type:Organization
Organization Name:ENLOW AND SHAHZAD ASSOCIATES IN MEDICINE,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:ENLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-236-4216
Mailing Address - Street 1:105 PONDER CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9050
Mailing Address - Country:US
Mailing Address - Phone:859-236-4216
Mailing Address - Fax:859-238-9760
Practice Address - Street 1:105 PONDER CT
Practice Address - Street 2:SUITE 104
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-9050
Practice Address - Country:US
Practice Address - Phone:859-236-4216
Practice Address - Fax:859-238-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65901522Medicaid
KY65901522Medicaid