Provider Demographics
NPI:1205854114
Name:REDA, HASSAN KHALIL (MD)
Entity Type:Individual
Prefix:DR
First Name:HASSAN
Middle Name:KHALIL
Last Name:REDA
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 1:740 S. LIMESTONE
Mailing Address - Street 2:A301
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0284
Mailing Address - Country:US
Mailing Address - Phone:859-323-4934
Mailing Address - Fax:859-257-4682
Practice Address - Street 1:740 S. LIMESTONE
Practice Address - Street 2:A301
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0284
Practice Address - Country:US
Practice Address - Phone:859-323-4934
Practice Address - Fax:859-257-4682
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9882208G00000X
KY41214208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY41214OtherKBML
TX8M8862OtherBLUE CROSS
TX151000002Medicaid
TX8B6558Medicare ID - Type Unspecified