Provider Demographics
NPI:1922084391
Name:LIVAS, IRAKLIS C (MD)
Entity Type:Individual
Prefix:DR
First Name:IRAKLIS
Middle Name:C
Last Name:LIVAS
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 1:1019 MAJESTIC DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1895
Mailing Address - Country:US
Mailing Address - Phone:859-277-3114
Mailing Address - Fax:859-275-1942
Practice Address - Street 1:1019 MAJESTIC DR
Practice Address - Street 2:SUITE 210
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1895
Practice Address - Country:US
Practice Address - Phone:859-277-3114
Practice Address - Fax:859-275-1942
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY32228207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64322282Medicaid
KY7373Medicare ID - Type Unspecified
KY6928Medicare ID - Type Unspecified
KY64322282Medicaid
KY7452Medicare ID - Type Unspecified
KY6927Medicare ID - Type Unspecified