Provider Demographics
NPI:1609361724
Name:BLUEGRASS INTERNAL MEDICINE AND NEPHROLOGY
Entity Type:Organization
Organization Name:BLUEGRASS INTERNAL MEDICINE AND NEPHROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAZEM
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-456-7181
Mailing Address - Street 1:4101 TATES CREEK CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-3066
Mailing Address - Country:US
Mailing Address - Phone:816-456-7181
Mailing Address - Fax:
Practice Address - Street 1:4101 TATES CREEK CENTRE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3066
Practice Address - Country:US
Practice Address - Phone:816-456-7181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-30
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty