Provider Demographics
NPI:1437494291
Name:SULTANA FAIYAZ CORPORATION, LLC
Entity Type:Organization
Organization Name:SULTANA FAIYAZ CORPORATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RASHID
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIYAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-344-9061
Mailing Address - Street 1:PO BOX 221515
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-1515
Mailing Address - Country:US
Mailing Address - Phone:937-344-9061
Mailing Address - Fax:502-412-9817
Practice Address - Street 1:4001 DUTCHMANS LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4714
Practice Address - Country:US
Practice Address - Phone:502-893-1000
Practice Address - Fax:502-412-9817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty