Basic Information
| Provider Information | |||||||||
| NPI: | 1437494291 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SULTANA FAIYAZ CORPORATION, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 221515 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402521515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373449061 | ||||||||
| FaxNumber: | 5024129817 | ||||||||
| Practice Location | |||||||||
| Address1: | 4001 DUTCHMANS LN | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028931000 | ||||||||
| FaxNumber: | 5024129817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2012 | ||||||||
| LastUpdateDate: | 12/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | FAIYAZ | ||||||||
| AuthorizedOfficialFirstName: | RASHID | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9373449061 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.