Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2082S0105X | Plastic Hand Surgeon | FT596 | KY |
NPI | 1790339539 |
---|---|
Provider Name | Ahad Attiah |
First Address | Louisville, KY 40202-1858 |
Second Address | Louisville, KY 40202-1858 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2019 |
Last Update Date | 30/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FT596 | STATE LICENSE (01) | KY |