Provider Demographics
NPI:1437294386
Name:DASHTI, SHERVIN R (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHERVIN
Middle Name:R
Last Name:DASHTI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:SHERVIN
Other - Middle Name:
Other - Last Name:RAHIMDASHTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST STE 1105
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3907
Practice Address - Country:US
Practice Address - Phone:502-583-1697
Practice Address - Fax:502-583-2120
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42812207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000023036POtherHUMANA - NNIKY
KY000000620686OtherANTHEM - NNIKY
KY7100075290Medicaid
KYP00739667OtherRAILROAD MEDICARE - KY
IN200952350Medicaid
KY105136OtherSIHO - NNIKY
KY000023036POtherHUMANA - NNIKY
KYP00739667OtherRAILROAD MEDICARE - KY
KY7100075290Medicaid