Provider Demographics
NPI:1902846157
Name:FAHSAH, IBRAHIM (MD)
Entity Type:Individual
Prefix:MR
First Name:IBRAHIM
Middle Name:
Last Name:FAHSAH
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 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-916-1055
Mailing Address - Fax:
Practice Address - Street 1:201 ABRAHAM FLEXNER WAY STE 903
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3832
Practice Address - Country:US
Practice Address - Phone:502-916-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32990174400000X, 207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50019752OtherPASSPORT
KY000057094OOtherHUMANA- CTS
KY353176400OtherPASSPORT ADVANTAGE
KY50031678OtherPASSPORT- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY108285OtherANTHEM- CTS
IN200122110Medicaid
KY5151604OtherAETNA- CTS
KYP00468647OtherRAILROAD MEDICARE
KY64329907Medicaid
KYP00924103OtherRAILROAD MEDICARE- CTS
KY50031678OtherPASSPORT- CARDIOTHORACIC SURGERY OF LOUISVILLE
KY64329907Medicaid
KY000057094OOtherHUMANA- CTS
KY5151604OtherAETNA- CTS
KY0609035Medicare ID - Type Unspecified
KYP400036726Medicare PIN