Provider Demographics
NPI:1285740175
Name:EASTERN KY ALLERGY AND ASTHMA PLLC
Entity type:Organization
Organization Name:EASTERN KY ALLERGY AND ASTHMA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:SARAF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-285-9222
Mailing Address - Street 1:PO BOX 1825
Mailing Address - Street 2:
Mailing Address - City:PRESTONBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653
Mailing Address - Country:US
Mailing Address - Phone:606-285-9222
Mailing Address - Fax:606-285-9223
Practice Address - Street 1:11021 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649
Practice Address - Country:US
Practice Address - Phone:606-285-9222
Practice Address - Fax:606-285-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36402207KA0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65944704Medicaid
9951Medicare ID - Type Unspecified