Provider Demographics
NPI:1821193533
Name:IKRAM, FARAH S (MD)
Entity type:Individual
Prefix:DR
First Name:FARAH
Middle Name:S
Last Name:IKRAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 PARK PLAZA AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2236
Mailing Address - Country:US
Mailing Address - Phone:502-425-3148
Mailing Address - Fax:502-425-3149
Practice Address - Street 1:9700 PARK PLAZA AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2236
Practice Address - Country:US
Practice Address - Phone:502-425-3148
Practice Address - Fax:502-425-3149
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33872207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200259330BMedicaid
KY50017269OtherPASSPORT
KY6433872600Medicaid
KY6433872600Medicaid
KY00451001Medicare PIN