Provider Demographics
NPI:1346736857
Name:ABU FARSAK, HISHAM
Entity Type:Individual
Prefix:
First Name:HISHAM
Middle Name:
Last Name:ABU FARSAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BURLEY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-8725
Mailing Address - Country:US
Mailing Address - Phone:270-538-5880
Mailing Address - Fax:
Practice Address - Street 1:1532 LONE OAK RD STE 315
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7942
Practice Address - Country:US
Practice Address - Phone:270-538-5880
Practice Address - Fax:270-538-5870
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY56366207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology