Provider Demographics
NPI:1225147234
Name:KAHLEIFEH, BASIM (MD)
Entity Type:Individual
Prefix:DR
First Name:BASIM
Middle Name:
Last Name:KAHLEIFEH
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 1:118 PATRIOT DRIVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004
Mailing Address - Country:US
Mailing Address - Phone:502-348-8100
Mailing Address - Fax:502-348-8900
Practice Address - Street 1:118 PATRIOT DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004
Practice Address - Country:US
Practice Address - Phone:502-348-8100
Practice Address - Fax:502-348-8900
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10224207V00000X
NM2001-49207V00000X
KY36376207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64033657Medicaid
H81667Medicare UPIN
1934301Medicare ID - Type Unspecified