Provider Demographics
NPI:1275737082
Name:TAVAKOLI, ZAHRA (MD)
Entity Type:Individual
Prefix:
First Name:ZAHRA
Middle Name:
Last Name:TAVAKOLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 ELAINE DR
Mailing Address - Street 2:#204
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2754
Mailing Address - Country:US
Mailing Address - Phone:859-258-4339
Mailing Address - Fax:859-258-6122
Practice Address - Street 1:3061 FIELDSTONE WAY
Practice Address - Street 2:SUITE 700
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-9006
Practice Address - Country:US
Practice Address - Phone:859-296-9900
Practice Address - Fax:859-296-9603
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY43185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100111780Medicaid
KY7100111780Medicaid
PAI14632Medicare UPIN