Provider Demographics
NPI:1639157456
Name:BACHA, FADI (MD)
Entity Type:Individual
Prefix:
First Name:FADI
Middle Name:
Last Name:BACHA
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 1:3116 HARRODSBURG RD.
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503
Mailing Address - Country:US
Mailing Address - Phone:859-687-0023
Mailing Address - Fax:859-268-0086
Practice Address - Street 1:3116 HARRODSBURG RD.
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-687-0023
Practice Address - Fax:859-268-0086
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32006207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64320005Medicaid
G43720Medicare UPIN
KY64320005Medicaid
KY0693001Medicare ID - Type Unspecified
KY0692901Medicare ID - Type Unspecified