Provider Demographics
NPI:1346794609
Name:EL HAJ, MADI (MD)
Entity Type:Individual
Prefix:
First Name:MADI
Middle Name:
Last Name:EL HAJ
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:CHRISTINE M KLEINERT INSTITUTE 225 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:SUITE 850
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-562-0312
Mailing Address - Fax:502-562-0326
Practice Address - Street 1:CHRISTINE M KLEINERT INSTITUTE 225 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 850
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-562-0312
Practice Address - Fax:502-562-0326
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYFT560390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program