Provider Demographics
NPI:1598752248
Name:MAKDESSIAN, ARA S (MD)
Entity Type:Individual
Prefix:DR
First Name:ARA
Middle Name:S
Last Name:MAKDESSIAN
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 1:225 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 265, CLARK CLINIC B
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1156
Mailing Address - Country:US
Mailing Address - Phone:859-745-1010
Mailing Address - Fax:
Practice Address - Street 1:225 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 265, CLARK CLINIC B
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1156
Practice Address - Country:US
Practice Address - Phone:859-745-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39412207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH55546Medicare UPIN
KY0957901Medicare ID - Type Unspecified