Provider Demographics
NPI:1841564291
Name:LOUISVILLE LUNG CARE PLLC
Entity Type:Organization
Organization Name:LOUISVILLE LUNG CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:MOUTAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-NABHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-691-2223
Mailing Address - Street 1:PO BOX 22225
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-0225
Mailing Address - Country:US
Mailing Address - Phone:918-691-2223
Mailing Address - Fax:502-410-0484
Practice Address - Street 1:3999 DUTCHMANS LN
Practice Address - Street 2:SUITE 2F
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4729
Practice Address - Country:US
Practice Address - Phone:502-883-0227
Practice Address - Fax:502-410-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42043207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100142140Medicaid
KY7100142140Medicaid