Provider Demographics
NPI:1063511095
Name:MIKHAIL WASSEF, MAHA BOTROS (MD)
Entity Type:Individual
Prefix:
First Name:MAHA
Middle Name:BOTROS
Last Name:MIKHAIL WASSEF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAHA
Other - Middle Name:B
Other - Last Name:MIKHAIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-489-5730
Mailing Address - Fax:502-489-5753
Practice Address - Street 1:4003 KRESGE WAY
Practice Address - Street 2:SUITE 221
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4652
Practice Address - Country:US
Practice Address - Phone:502-897-7107
Practice Address - Fax:502-897-7613
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040740207RC0000X, 207UN0901X
IL036126126207RC0000X
VA0101240731207RC0000X, 207UN0901X
NJ25MA08180200207RC0000X
NJ25MA08181200207UN0901X
KYTP865207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00140740300Medicaid
CT00140740300Medicaid
CT060001484Medicare ID - Type Unspecified