Organization
INFECTIOUS DISEASES SPECIALISTS OF KENTUCKIANA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMMAR TAYARA MD (MEMBER)
(812) 949-3242
Entity
Organization
Contact information
Practice address
1220 MISSOURI AVE, JEFFERSONVILLE, IN 47130-3725
(812) 949-3242
Mailing address
17027 ASHBURTON DR, LOUISVILLE, KY 40245-5713
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RI0200X
Infectious Disease Physician
Primary
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000883842
ANTHEM
IN
05
—
201244550
—
IN
05
—
7100359690
—
KY
05
—
7100447670
—
KY
01
—
DV0764
RAILROAD MEDICARE
IN
01
—
DV8435
RAILROAD MEDICARE
KY
Enumeration date
06/20/2014
Last updated
03/29/2017
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