Individual
ABDUL M MEMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4402 CHURCHMAN AVENUE, SUITE 305, LOUISVILLE, KY 40215
(502) 368-9590
(502) 368-9616
Mailing address
4402 CHURCHMAN AVENUE, SUITE 305, LOUISVILLE, KY 40215
(502) 368-9590
(502) 368-9616
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
R8838
MO
207RP1001X
Pulmonary Disease Physician
Primary
40505
KY
207RP1001X
Pulmonary Disease Physician
R8838
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000511828
ANTHEM
—
05
—
201413549
—
MO
01
—
213320E
MEDICARE
IN
Enumeration date
08/20/2006
Last updated
09/08/2014
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