Provider Demographics
NPI:1174516751
Name:NAZIR, ARIF (MD)
Entity type:Individual
Prefix:
First Name:ARIF
Middle Name:
Last Name:NAZIR
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 1:12201 BLUEGRASS PKWY
Mailing Address - Street 2:STE 130 - PROVIDER ENROLLMENT
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2361
Mailing Address - Country:US
Mailing Address - Phone:502-568-7364
Mailing Address - Fax:502-568-7136
Practice Address - Street 1:1120 CRISTLAND RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-4150
Practice Address - Country:US
Practice Address - Phone:502-367-0140
Practice Address - Fax:502-368-5208
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49556207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4462980Medicaid
IN200874940Medicaid
IN200874940Medicaid
INP01294238Medicare PIN
MIH78960Medicare UPIN
IN264430109Medicare PIN