Provider Demographics
NPI:1295886596
Name:TAHANASAB, ABDOLKARIM (MD)
Entity type:Individual
Prefix:
First Name:ABDOLKARIM
Middle Name:
Last Name:TAHANASAB
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 1:6 PHYSICIANS PARK
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4108
Mailing Address - Country:US
Mailing Address - Phone:502-875-1559
Mailing Address - Fax:
Practice Address - Street 1:6 PHYSICIANS PARK
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4108
Practice Address - Country:US
Practice Address - Phone:502-875-1559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17210207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64172109Medicaid
KY61-0919723OtherHUMANA
KY61-0919723OtherBLUEGRASS FAMILY HEALTH
KY61-0919723OtherBLUEGRASS FAMILY HEALTH
KYC69536Medicare UPIN