Provider Demographics
NPI:1386601334
Name:NASRATY, SORAYA P (MD)
Entity type:Individual
Prefix:
First Name:SORAYA
Middle Name:P
Last Name:NASRATY
Suffix:
Gender:F
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:1930 BISHOP LN
Practice Address - Street 2:SUITE 1600
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1921
Practice Address - Country:US
Practice Address - Phone:502-272-5034
Practice Address - Fax:502-272-5117
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28191207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200099340Medicaid
KYP00800039OtherRAILROAD MCR-KY
KY64281918Medicaid
KY108056OtherSIHO - NICC
KY0766110Medicare PIN
KY1271178Medicare PIN
KY0048427Medicare PIN
KY00533183Medicare PIN
F20498Medicare UPIN
KY64281918Medicaid
IN200099340Medicaid
KY0601201Medicare PIN
KY0631204Medicare PIN