Provider Demographics
NPI:1194919159
Name:KHAWARI, ABBAS ALI (MD)
Entity type:Individual
Prefix:
First Name:ABBAS
Middle Name:ALI
Last Name:KHAWARI
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 950137
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0137
Mailing Address - Country:US
Mailing Address - Phone:
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:
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1066082A207R00000X
KY40695207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000814741OtherANTHEM
KY7100025260Medicaid
IN200970750Medicaid
KY50102205OtherPASSPORT HEALTH PLAN
KYP01601393OtherRAILROAD MEDICARE
KY50102205OtherPASSPORT HEALTH PLAN
50026231OtherNICS/PHP
KYK041440Medicare PIN
KY0538580Medicare PIN
KY0637748Medicare PIN
IN200970750Medicaid
3745096000OtherNICS/PAD
KY0533195Medicare PIN
KY0795621Medicare PIN
INM400071216Medicare PIN
50026231OtherNICS/PHP
KY0537782Medicare PIN
KYK041440Medicare PIN
00052152JOtherNICS/HUMANA
634114OtherNICS/ANTHEM
KY0538682Medicare PIN