Provider Demographics
NPI:1255497822
Name:MAYEL, SAMIR (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:MAYEL
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 22787
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-0787
Mailing Address - Country:US
Mailing Address - Phone:859-814-1486
Mailing Address - Fax:
Practice Address - Street 1:5107 CRAIGS CREEK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-4863
Practice Address - Country:US
Practice Address - Phone:859-393-3124
Practice Address - Fax:440-332-3844
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39848207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64121627Medicaid
KY000000620980OtherANTHEM
IN200934970Medicaid
KYP00753610OtherMEDICARE RAILROAD PIN
IN262180BMedicare PIN
IN200934970Medicaid