Provider Demographics
NPI:1073515227
Name:NAIR, AJITH (MD)
Entity Type:Individual
Prefix:
First Name:AJITH
Middle Name:
Last Name:NAIR
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:PO BOX 24261
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40224-0261
Mailing Address - Country:US
Mailing Address - Phone:502-995-4004
Mailing Address - Fax:502-933-5559
Practice Address - Street 1:3710 CHAMBERLAIN LN
Practice Address - Street 2:STE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241
Practice Address - Country:US
Practice Address - Phone:502-995-4004
Practice Address - Fax:502-933-5559
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36217174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1073515227OtherMEDICARE NPI
KY64024896Medicaid
KY64024896Medicaid