Provider Demographics
NPI:1326571068
Name:AMIR-KABIRIAN, MAHSA (MD)
Entity Type:Individual
Prefix:MS
First Name:MAHSA
Middle Name:
Last Name:AMIR-KABIRIAN
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 1:3939 7TH STREET RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4103
Mailing Address - Country:US
Mailing Address - Phone:502-883-6800
Mailing Address - Fax:502-384-2316
Practice Address - Street 1:3939 7TH STREET RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4103
Practice Address - Country:US
Practice Address - Phone:502-883-6800
Practice Address - Fax:502-384-2316
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2020-07-08
Deactivation Date:2017-11-17
Deactivation Code:
Reactivation Date:2017-11-27
Provider Licenses
StateLicense IDTaxonomies
KY52943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine