Provider Demographics
NPI:1578819108
Name:MIRZA, FARHAN ARSHAD (MBBS)
Entity Type:Individual
Prefix:DR
First Name:FARHAN
Middle Name:ARSHAD
Last Name:MIRZA
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST # MS 101
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0298
Mailing Address - Country:US
Mailing Address - Phone:859-323-6263
Mailing Address - Fax:859-323-1127
Practice Address - Street 1:800 ROSE ST # MS 101
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0298
Practice Address - Country:US
Practice Address - Phone:859-323-6263
Practice Address - Fax:859-323-1127
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2987207T00000X
KY52701207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100267150Medicaid