Provider Demographics
NPI:1154531416
Name:ADDASI, ALAA (MD)
Entity type:Individual
Prefix:
First Name:ALAA
Middle Name:
Last Name:ADDASI
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:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-430-2201
Mailing Address - Fax:606-218-4651
Practice Address - Street 1:911 BYPASS RD BLDG A
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1689
Practice Address - Country:US
Practice Address - Phone:606-430-2201
Practice Address - Fax:606-218-4651
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY416132086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2837096Medicaid
WV3810013043Medicaid
KY7100047870Medicaid
KYP400043317Medicare PIN
WV3810013043Medicaid
KY7100047870Medicaid
OH2837096Medicaid