Provider Demographics
NPI:1467718049
Name:ABDULLAH, FATEN (MD)
Entity Type:Individual
Prefix:
First Name:FATEN
Middle Name:
Last Name:ABDULLAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 COMMERCE CROSSINGS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-253-4977
Mailing Address - Fax:502-489-5751
Practice Address - Street 1:720 W HILL ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2216
Practice Address - Country:US
Practice Address - Phone:502-636-3164
Practice Address - Fax:502-634-3731
Is Sole Proprietor?:No
Enumeration Date:2012-04-08
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47864207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000931450OtherANTHEM - NICC
KY50090549OtherPASSPORT - NICC
KY7100352410Medicaid
KY177876OtherSIHO - NICC
KY50090549OtherPASSPORT - NICC