Provider Demographics
NPI:1952875213
Name:ELGHAOUTH, HANANY
Entity Type:Individual
Prefix:
First Name:HANANY
Middle Name:
Last Name:ELGHAOUTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11913 TAZWELL DR APT 8
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-2710
Mailing Address - Country:US
Mailing Address - Phone:502-424-7777
Mailing Address - Fax:
Practice Address - Street 1:11913 TAZWELL DR APT 8
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-2710
Practice Address - Country:US
Practice Address - Phone:502-424-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)