Provider Demographics
NPI:1184789364
Name:PEDIATRIC SPECIALISTS LLC
Entity type:Organization
Organization Name:PEDIATRIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESTIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALJABI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-830-0313
Mailing Address - Street 1:505 KLUTEY PARK PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-5224
Mailing Address - Country:US
Mailing Address - Phone:270-830-0313
Mailing Address - Fax:270-830-7117
Practice Address - Street 1:505 KLUTEY PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-5224
Practice Address - Country:US
Practice Address - Phone:270-830-0313
Practice Address - Fax:270-830-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY274112080N0001X
KY274102080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
Not Answered2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty