Provider Demographics
NPI:1184742389
Name:AYOOB, ANDRES R (MD)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:R
Last Name:AYOOB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:800 ROSE ST
Mailing Address - Street 2:HX-315A
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-2410
Mailing Address - Fax:859-257-4457
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:HX-315A
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-323-2410
Practice Address - Fax:859-257-4457
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301081574390200000X
VA01012456692085R0202X
KY435242085R0202X
KY428922085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184742389Medicaid
KY7100125580Medicaid
VA1184742389Medicaid