Basic Information
| Provider Information | |||||||||
| NPI: | 1467718049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABDULLAH | ||||||||
| FirstName: | FATEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5200 COMMERCE CROSSINGS DR | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402292182 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022534977 | ||||||||
| FaxNumber: | 5024895751 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 W HILL ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402082216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026363164 | ||||||||
| FaxNumber: | 5026343731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2012 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 47864 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000931450 | 01 | KY | ANTHEM - NICC | OTHER | 50090549 | 01 | KY | PASSPORT - NICC | OTHER | 7100352410 | 05 | KY | MEDICAID | 177876 | 01 | KY | SIHO - NICC | OTHER |