Provider Demographics
NPI:1124009659
Name:VAEZY, ABDI (MD)
Entity Type:Individual
Prefix:
First Name:ABDI
Middle Name:
Last Name:VAEZY
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 1325
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-1325
Mailing Address - Country:US
Mailing Address - Phone:606-526-8131
Mailing Address - Fax:606-528-8661
Practice Address - Street 1:14949 N US HIGHWAY 25 E
Practice Address - Street 2:SUITE 6
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-6285
Practice Address - Country:US
Practice Address - Phone:606-528-0009
Practice Address - Fax:606-528-0091
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25857207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64258577Medicaid
KYP01427260OtherRR MEDICARE
KY64258577Medicaid
KYK039002Medicare PIN
KY64258577Medicaid