Basic Information
| Provider Information | |||||||||
| NPI: | 1174516751 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NAZIR | ||||||||
| FirstName: | ARIF | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12201 BLUEGRASS PKWY | ||||||||
| Address2: | STE 130 - PROVIDER ENROLLMENT | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402992361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025687364 | ||||||||
| FaxNumber: | 5025687136 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 CRISTLAND RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402144150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023670140 | ||||||||
| FaxNumber: | 5023685208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2005 | ||||||||
| LastUpdateDate: | 11/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 49556 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207R00000X | 49556 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4462980 | 05 | MI | MEDICAID | 200874940 | 05 | IN | MEDICAID |