Provider Demographics
NPI:1932565314
Name:AAK INTERNAL MEDICINE PLLC
Entity Type:Organization
Organization Name:AAK INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAWARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-445-4222
Mailing Address - Street 1:9203 BERGAMOT DR
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-6585
Mailing Address - Country:US
Mailing Address - Phone:502-742-7062
Mailing Address - Fax:
Practice Address - Street 1:1 AUDUBON PLAZA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1318
Practice Address - Country:US
Practice Address - Phone:502-742-7062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201347020Medicaid
KYDW3039OtherRAILROAD MEDICARE
KY7100400190Medicaid
KY50102201OtherPASSPORT HEALTH PLAN
KYK041441Medicare PIN