Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 41613 | KY |
NPI | 1154531416 |
---|---|
Provider Name | Alaa Addasi |
First Address | Pikeville, KY 41502-0432 |
Second Address | Pikeville, KY 41501-1689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 28/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2837096 | (05) | OH |
3810013043 | (05) | WV |
7100047870 | (05) | KY |