Provider Demographics
NPI:1558513416
Name:KENTUCKIANA HEART DOCTORS INC
Entity Type:Organization
Organization Name:KENTUCKIANA HEART DOCTORS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SYED
Authorized Official - Middle Name:T
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-542-1880
Mailing Address - Street 1:PO BOX 950103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0103
Mailing Address - Country:US
Mailing Address - Phone:812-542-1880
Mailing Address - Fax:812-542-1891
Practice Address - Street 1:1919 STATE STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6806
Practice Address - Country:US
Practice Address - Phone:812-542-1880
Practice Address - Fax:812-542-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32779174400000X
207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty