# INFECTIOUS DISEASES SPECIALISTS OF KENTUCKIANA LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740694421
- **Authorized official:** AMMAR TAYARA MD (MEMBER)
- **Authorized official phone:** (812) 949-3242

## Contact information

- **Practice address:** 1220 MISSOURI AVE, JEFFERSONVILLE, IN 47130-3725
- **Practice address phone:** (812) 949-3242
- **Mailing address:** 17027 ASHBURTON DR, LOUISVILLE, KY 40245-5713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RI0200X | Infectious Disease Physician | — | NULL | Yes |
| 207RI0200X | Infectious Disease Physician | — | — | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | — | NULL | — |
| 363LG0600X | Gerontology Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 06/20/2014
- **Last updated:** 03/29/2017