Provider Demographics
NPI:1497150205
Name:PULMONARY CARE SERVICE LLC
Entity Type:Organization
Organization Name:PULMONARY CARE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MHD
Authorized Official - Middle Name:HAITHAM
Authorized Official - Last Name:CHAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-633-1151
Mailing Address - Street 1:720 HOSPITAL DR
Mailing Address - Street 2:STE 106
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1685
Mailing Address - Country:US
Mailing Address - Phone:502-633-1151
Mailing Address - Fax:
Practice Address - Street 1:720 HOSPITAL DR
Practice Address - Street 2:STE 106
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1685
Practice Address - Country:US
Practice Address - Phone:502-633-1151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35377207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000901376OtherBCBS
KY9870OtherHUMANA
KY9870OtherHUMANA