Individual
MAZEN KHAYAT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
801 BARRET AVE, SUITE 104, LOUISVILLE, KY 40204-1747
(502) 589-9310
(502) 583-5560
Mailing address
801 BARRET AVE, SUITE 104, LOUISVILLE, KY 40204-1747
(502) 589-9310
(502) 583-5560
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01044238A
IN
207R00000X
Internal Medicine Physician
01044238A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200065880
—
IN
Enumeration date
05/26/2006
Last updated
04/05/2022
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