Provider Demographics
NPI:1518908243
Name:ALJABI, IYAD A (MD)
Entity Type:Individual
Prefix:DR
First Name:IYAD
Middle Name:A
Last Name:ALJABI
Suffix:
Gender:M
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:PO BOX 766351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:505 KLUTEY PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-5224
Practice Address - Country:US
Practice Address - Phone:270-830-0313
Practice Address - Fax:270-830-7117
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY274112080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64274111Medicaid
1641601Medicare ID - Type Unspecified
KY64274111Medicaid