Provider Demographics
NPI:1316948961
Name:IKRAM, ATIF
Entity type:Individual
Prefix:MR
First Name:ATIF
Middle Name:
Last Name:IKRAM
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 1:906 WOODLAND DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2752
Mailing Address - Country:US
Mailing Address - Phone:270-765-5127
Mailing Address - Fax:270-765-2653
Practice Address - Street 1:906 WOODLAND DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2752
Practice Address - Country:US
Practice Address - Phone:270-765-5127
Practice Address - Fax:270-765-2653
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 0343231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY70000187Medicaid
KY70000187Medicaid
1453906Medicare ID - Type Unspecified