Organization
INFECTIOUS DISEASES SPECIALISTS OF KENTUCKIANA LLC
Active
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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