Organization
KIDNEY DOCTORS OF KENTUCKIANA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUAD A MAYA MD (OWNER)
(812) 283-9111
Entity
Organization
Contact information
Practice address
1035 WALL ST STE 103, JEFFERSONVILLE, IN 47130-3695
(812) 283-9111
(812) 283-9001
Mailing address
PO BOX 950195, LOUISVILLE, KY 40295-0195
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201363590
—
IN
01
—
50110029
PASSPORT HEALTH PLAN
KY
05
—
7100419990
—
KY
01
—
DW6469
RAILROAD MEDICARE
IN
Enumeration date
06/02/2016
Last updated
10/10/2016
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