Provider Demographics
NPI:1851395586
Name:NAZAR, GREGORY B (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:B
Last Name:NAZAR
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3 AUDUBON PLAZA DR
Practice Address - Street 2:SUITE 410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1300
Practice Address - Country:US
Practice Address - Phone:502-636-2667
Practice Address - Fax:502-636-2668
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26253174400000X, 207T00000X
IN01038382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50035437OtherPASSPORT
KYP00869554OtherMEDICARE RAILROAD- NIKKY
KY2557345OtherCIGNA - NNIKY
KY50029550OtherPASSPORT ADVANTAGE - NNIKY
KY000052153WOtherHUMANA - NNIKY
KY000000665482OtherANTHEM - NNIKY
KYK074600OtherMEDICARE KY - NNIKY
KY000000746161OtherANTHEM
IN100461820Medicaid
KY116194OtherSIHO - NNIKY
KY64262538Medicaid
KYP400017380Medicare PIN
KY50035437OtherPASSPORT
IN100461820Medicaid
KYP400017773Medicare PIN