Provider Demographics
NPI:1083777957
Name:LEXINGTON VEIN & AESTHETIC CENTER, PLLC
Entity Type:Organization
Organization Name:LEXINGTON VEIN & AESTHETIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FADI
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-269-4668
Mailing Address - Street 1:1055 DOVE RUN RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-3536
Mailing Address - Country:US
Mailing Address - Phone:859-269-4668
Mailing Address - Fax:
Practice Address - Street 1:1055 DOVE RUN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3536
Practice Address - Country:US
Practice Address - Phone:859-269-4668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty