Provider Demographics
NPI:1124012653
Name:ABAYEV, NISON I (MD)
Entity Type:Individual
Prefix:
First Name:NISON
Middle Name:I
Last Name:ABAYEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-995-7775
Mailing Address - Fax:502-995-7765
Practice Address - Street 1:10300 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272
Practice Address - Country:US
Practice Address - Phone:502-995-7775
Practice Address - Fax:502-995-7765
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY35821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64052285Medicaid
KY64052285Medicaid
KY1007306Medicare PIN
KYP00805579Medicare PIN
KY080172199Medicare PIN
KY00546261Medicare Oscar/Certification