Provider Demographics
NPI:1043207228
Name:ANSARI, IRFAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IRFAN
Middle Name:
Last Name:ANSARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 DIAGNOSTIC DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-6524
Mailing Address - Country:US
Mailing Address - Phone:502-875-9860
Mailing Address - Fax:502-875-9887
Practice Address - Street 1:100 DIAGNOSTIC DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-6524
Practice Address - Country:US
Practice Address - Phone:502-875-9860
Practice Address - Fax:502-875-9887
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41652207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108906Medicaid
084219OtherHEALTH ALLIANCE
238798OtherHARMONY HEALTH PLAN
539545OtherHEALTHLINK
ILP00023307OtherMEDICARE RAILROAD
539545OtherHEALTHLINK
IL036108906Medicaid