Provider Demographics
NPI:1891709515
Name:ABOUD, MICHELLE J (MD)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:J
Last Name:ABOUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 BRECKENRIDGE LANE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4748
Mailing Address - Country:US
Mailing Address - Phone:024-735-8065
Mailing Address - Fax:502-473-8066
Practice Address - Street 1:710 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4504
Practice Address - Country:US
Practice Address - Phone:502-473-8065
Practice Address - Fax:502-473-8066
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000176586OtherANTHEM
KY64017346Medicaid
110212179OtherRR MEDICARE
KYBA6932734OtherDEA
110212179OtherRR MEDICARE
KYBA6932734OtherDEA