Provider Demographics
NPI:1447222781
Name:YAZDANI, AIJAZ A (MD)
Entity Type:Individual
Prefix:MR
First Name:AIJAZ
Middle Name:A
Last Name:YAZDANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:AIJAZ
Other - Middle Name:A
Other - Last Name:YAZDANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:914 N DIXIE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2520
Mailing Address - Country:US
Mailing Address - Phone:270-735-9066
Mailing Address - Fax:270-735-9036
Practice Address - Street 1:914 N DIXIE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2520
Practice Address - Country:US
Practice Address - Phone:270-735-9066
Practice Address - Fax:270-735-9036
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32878207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64328784Medicaid
KY7255OtherMEDICARE PTAN
KY290014995OtherRAILROAD MEDICARE
KY64328784Medicaid
KY290014995OtherRAILROAD MEDICARE