Individual
DR. ABDOLREZA AGAHTEHRANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6420 DUTCHMANS PKWY, STE 200, LOUISVILLE, KY 40205-3372
(502) 891-8300
Mailing address
PO BOX 950202, LOUISVILLE, KY 40295-0202
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
43033
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000635481
ANTHEM
—
01
—
000000693017
ANTHEM - NCVA
KY
01
—
000057058W
HUMANA - NCVA
KY
05
—
201044560
—
IN
01
—
3737980000
PASSPORT ADVANTAGE
—
01
—
50025829
PASSPORT
—
01
—
50031143
PASSPORT & PASSPORT ADVTG - NCVA
KY
05
—
7100045440
—
KY
01
—
P00893011
RAILROAD MEDICARE - NCVA
KY
Enumeration date
08/28/2006
Last updated
09/17/2014
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