Provider Demographics
NPI:1770985863
Name:BLUEGRASS CARDIOLOGY LLC
Entity type:Organization
Organization Name:BLUEGRASS CARDIOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAMIK
Authorized Official - Middle Name:
Authorized Official - Last Name:AIKAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-358-2830
Mailing Address - Street 1:128 MAHOGANY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-9823
Mailing Address - Country:US
Mailing Address - Phone:859-358-2830
Mailing Address - Fax:859-368-8135
Practice Address - Street 1:989 GOVERNORS LN
Practice Address - Street 2:SUITE 180
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1173
Practice Address - Country:US
Practice Address - Phone:859-358-2830
Practice Address - Fax:859-368-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37861207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty