Provider Demographics
NPI:1245488659
Name:BLEIBEL, HANI A (MD)
Entity type:Individual
Prefix:DR
First Name:HANI
Middle Name:A
Last Name:BLEIBEL
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 1:908 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:LEITCHFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42754-1479
Mailing Address - Country:US
Mailing Address - Phone:270-259-9316
Mailing Address - Fax:270-230-0293
Practice Address - Street 1:910 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:LEITCHFIELD
Practice Address - State:KY
Practice Address - Zip Code:42754-2414
Practice Address - Country:US
Practice Address - Phone:270-259-9316
Practice Address - Fax:270-230-0293
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093284207R00000X
MS20716207P00000X, 208M00000X
KY44934207RN0300X, 207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000766160OtherANTHEM
KY50042658OtherPASSPORT MEDICAID
KY7100219350Medicaid
KY50042658OtherPASSPORT MEDICAID
MS302I117165Medicare PIN
KYK051692Medicare PIN
KYK051690Medicare PIN