Provider Demographics
NPI:1811962350
Name:ALREFAI, HISHAM A (MD)
Entity type:Individual
Prefix:
First Name:HISHAM
Middle Name:A
Last Name:ALREFAI
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 1:9720 PARK PLAZA AVE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2289
Mailing Address - Country:US
Mailing Address - Phone:502-895-8218
Mailing Address - Fax:502-895-8219
Practice Address - Street 1:9720 PARK PLAZA AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2289
Practice Address - Country:US
Practice Address - Phone:502-895-8218
Practice Address - Fax:502-895-8219
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055359A207R00000X
KY37214207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY149327OtherSIHO - NCMA
MA50053026OtherPASSPORT - NCMA
KY000000831435OtherANTHEM - NCMA
IN200385521Medicaid
KY64055395Medicaid
IN940540SSSSOtherLEGACY MEDICARE
IN200385521Medicaid
KY64055395Medicaid
IN940540SSSSOtherLEGACY MEDICARE