Provider Demographics
NPI:1558322172
Name:MAYA, MUAD (MD)
Entity Type:Individual
Prefix:
First Name:MUAD
Middle Name:
Last Name:MAYA
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 1:2200 POLO MOUNT CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1035 WALL ST STE 103
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3695
Practice Address - Country:US
Practice Address - Phone:812-283-9111
Practice Address - Fax:812-283-9001
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35833207RN0300X, 207R00000X
IN01051552A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64059876Medicaid
INP01669938OtherRAILROAD MEDICARE
IN200417620Medicaid
KYK203141Medicare UPIN
INP01669938OtherRAILROAD MEDICARE
H47105Medicare UPIN