Provider Demographics
NPI:1790895159
Name:ABADA, HICHAM TARIK (MD)
Entity Type:Individual
Prefix:
First Name:HICHAM
Middle Name:TARIK
Last Name:ABADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:HX319D
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-5069
Mailing Address - Fax:859-257-4457
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:HX319D
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-323-5069
Practice Address - Fax:859-257-4457
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IASP1822085R0202X, 2085R0204X
KYFL0322085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA23004OtherWELLMARK BCBS
IA0730085Medicaid
KY7100094330Medicaid
IAI61362Medicare UPIN
IA0730085Medicaid
IAP00341920Medicare PIN
KY00258371Medicare PIN