Provider Demographics
NPI:1174723662
Name:KHEETAN, REEM (MD)
Entity type:Individual
Prefix:
First Name:REEM
Middle Name:
Last Name:KHEETAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2917
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-2917
Mailing Address - Country:US
Mailing Address - Phone:606-218-3500
Mailing Address - Fax:
Practice Address - Street 1:140 ADAMS LN
Practice Address - Street 2:SUITE 600-700
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3087
Practice Address - Country:US
Practice Address - Phone:606-218-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45293207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100208660Medicaid
KY7100208660Medicaid