Provider Demographics
NPI:1023056959
Name:SAIFULLAH, YASIR (MD)
Entity type:Individual
Prefix:DR
First Name:YASIR
Middle Name:
Last Name:SAIFULLAH
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 1:103 FINANCIAL PL STE 100
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-4471
Mailing Address - Country:US
Mailing Address - Phone:270-769-0110
Mailing Address - Fax:270-765-6953
Practice Address - Street 1:103 FINANCIAL PL STE 100
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-4471
Practice Address - Country:US
Practice Address - Phone:270-769-0110
Practice Address - Fax:270-765-6953
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32932207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64329329Medicaid
KY64329329Medicaid