Organization
KENTUCKY GERIATRICS PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEYLA ZUBERI MD (OWNER)
(502) 544-6442
Entity
Organization
Contact information
Practice address
1705 HERR LN, LOUISVILLE, KY 40222-6545
(502) 544-6442
(502) 426-5493
Mailing address
PO BOX 950231, LOUISVILLE, KY 40295-0231
(502) 814-3170
(502) 814-3196
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65943813
—
KY
01
—
DD4794
RAILROAD MEDICARE
KY
Enumeration date
07/26/2005
Last updated
06/20/2011
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