Provider Demographics
NPI:1497943930
Name:ABDI VAEZY MD PLLC
Entity Type:Organization
Organization Name:ABDI VAEZY MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAEZY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-528-0009
Mailing Address - Street 1:1708 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2327
Mailing Address - Country:US
Mailing Address - Phone:606-528-0009
Mailing Address - Fax:606-528-0091
Practice Address - Street 1:1708 FOREST DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2327
Practice Address - Country:US
Practice Address - Phone:606-528-0009
Practice Address - Fax:606-528-0091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25857207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D47512Medicare UPIN
7056Medicare PIN