Provider Demographics
NPI:1013041391
Name:UNIVERSITY OF LOUISVILLE
Entity Type:Organization
Organization Name:UNIVERSITY OF LOUISVILLE
Other - Org Name:MAXILLOFACIAL ONCOLOGIC DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PROSTHODONTICS
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAFRULLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:502-852-5747
Mailing Address - Street 1:529 S JACKSON ST
Mailing Address - Street 2:# 127
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3229
Mailing Address - Country:US
Mailing Address - Phone:502-852-5747
Mailing Address - Fax:502-852-6132
Practice Address - Street 1:529 S JACKSON ST
Practice Address - Street 2:# 127
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3229
Practice Address - Country:US
Practice Address - Phone:502-852-5747
Practice Address - Fax:502-852-6132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100018200OtherINDIANA MEDICAID
KY775656OtherUNITED CONN
KY2438647000OtherPASSPORT ADVANTAGE
KY190005666OtherRR MEDICARE
KY60050671Medicaid
KY0003831OtherPASSPORT
KY000000175275OtherANTHEM BCBS
KY5651497OtherAETNA
KY60050671Medicaid
KY775656OtherUNITED CONN
KY775656OtherUNITED CONN
KY=========OtherUNITED HEALTHCARE