Provider Demographics
NPI:1699772707
Name:ABOU-JAOUDE, WALID A (MD)
Entity type:Individual
Prefix:DR
First Name:WALID
Middle Name:A
Last Name:ABOU-JAOUDE
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 1:1760 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1471
Mailing Address - Country:US
Mailing Address - Phone:859-277-5711
Mailing Address - Fax:859-278-0443
Practice Address - Street 1:1760 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1471
Practice Address - Country:US
Practice Address - Phone:859-277-5711
Practice Address - Fax:859-278-0443
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28947208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64712664Medicaid
KY64712664Medicaid
KYG49123Medicare UPIN
KY0542807Medicare PIN