Provider Demographics
NPI:1649265059
Name:POORKAY, MEHDI (MD)
Entity type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:
Last Name:POORKAY
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-559-9407
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:210 E GRAY ST STE 605
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-559-3636
Practice Address - Fax:502-629-5442
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-08-30
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
KY35245207R00000X, 174400000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY200812020OtherMANAGED HEALTH SERVICES
IN200812020Medicaid
KY200812020OtherANTHEM INDIANA MEDICAID- NORTON COMMUNITY MEDICAL ASSOCIATES
KY50019378OtherPASSPORT- NORTON INPATIENT SPECIALISTS
KYP00278628OtherRAILROAD MEDICARE
KY094640OtherSIHO- NORTON COMMUNITY MEDICAL ASSOCIATES
KY3754970000OtherPASSPORT ADVANTAGE- NORTON COMMUNITY MEDICAL ASSOCIATES
KY4601699OtherCIGNA- NORTON COMMUNITY MEDICAL ASSOCIATES
KY3527401000OtherPASSPORT ADVANTAGE- NIS
KY50026914OtherPASSPORT- NORTON COMMUNITY MEDICAL ASSOCIATES
KY64008535Medicaid
KY4601699OtherCIGNA- N. INPATIENT SPECIALISTS
KY200812020OtherMEDICAID INDIANA- NORTON INPATIENT SPECIALISTS
KY64008535Medicaid
KY3527401000OtherPASSPORT ADVANTAGE- NIS
KY200812020OtherMANAGED HEALTH SERVICES
KY4601699OtherCIGNA- NORTON COMMUNITY MEDICAL ASSOCIATES
KY50019378OtherPASSPORT- NORTON INPATIENT SPECIALISTS
KY64008535Medicaid