Provider Demographics
NPI:1700864329
Name:HASAN, RAFI A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAFI
Middle Name:A
Last Name:HASAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:250 E LIBERTY ST
Mailing Address - Street 2:STE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1530
Mailing Address - Country:US
Mailing Address - Phone:502-568-6722
Mailing Address - Fax:502-568-6733
Practice Address - Street 1:250 E LIBERTY ST
Practice Address - Street 2:STE200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1530
Practice Address - Country:US
Practice Address - Phone:502-568-6722
Practice Address - Fax:502-568-6733
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2013-08-06
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Provider Licenses
StateLicense IDTaxonomies
KY34260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64016033Medicaid
KY64016033Medicaid
KYH41899Medicare UPIN