Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | FT581 | KY |
NPI | 1275013609 |
---|---|
Provider Name | Imad Ismail Abushahin |
First Address | Louisville, KY 40202-3840 |
Second Address | Louisville, KY 40202-3840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 15/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FT581 | KENTUCKY BOARD OF MEDICAL LICENSURE (01) | KY |