Provider Demographics
NPI:1083788616
Name:JUSUFBEGOVIC, EDIN
Entity Type:Individual
Prefix:
First Name:EDIN
Middle Name:
Last Name:JUSUFBEGOVIC
Suffix:
Gender:M
Credentials:
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 740041
Mailing Address - Street 2:DEPT 5090
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-7441
Mailing Address - Country:US
Mailing Address - Phone:502-451-9949
Mailing Address - Fax:502-451-4553
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:KOSAIR CHILDREN'S HOSPITAL
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-451-9949
Practice Address - Fax:502-451-4553
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38351207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200842130Medicaid
KYK407590OtherMEDICARE
KY64129372Medicaid