Provider Demographics
NPI:1477622355
Name:IRAKLIS C LIVAS MD PSC
Entity Type:Organization
Organization Name:IRAKLIS C LIVAS MD PSC
Other - Org Name:ALLERGY ASTHMA AND IMMUNOLOGY PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-277-3114
Mailing Address - Street 1:1019 MAJESTIC DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1496
Mailing Address - Country:US
Mailing Address - Phone:859-277-3114
Mailing Address - Fax:859-275-1942
Practice Address - Street 1:1019 MAJESTIC DR STE 210
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1947
Practice Address - Country:US
Practice Address - Phone:859-277-3114
Practice Address - Fax:859-275-1942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6927Medicare UPIN
KY7373Medicare PIN
KY6928Medicare PIN