Provider Demographics
NPI:1609880301
Name:EAST END INFECTIOUS DISEASE, PLLC
Entity Type:Organization
Organization Name:EAST END INFECTIOUS DISEASE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHTAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-814-3171
Mailing Address - Street 1:2301 RIVER RD
Mailing Address - Street 2:#300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2093
Mailing Address - Country:US
Mailing Address - Phone:502-814-3171
Mailing Address - Fax:
Practice Address - Street 1:2301 RIVER RD
Practice Address - Street 2:#300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2093
Practice Address - Country:US
Practice Address - Phone:502-814-3171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34625207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9888Medicare ID - Type Unspecified