Provider Demographics
NPI:1962552240
Name:YARED, ISSAM F (MD)
Entity type:Individual
Prefix:
First Name:ISSAM
Middle Name:F
Last Name:YARED
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 1:2301 RIVER RD STE 302
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-3040
Mailing Address - Country:US
Mailing Address - Phone:502-814-3184
Mailing Address - Fax:502-814-3196
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:SUITE 305
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-634-0072
Practice Address - Fax:502-636-7130
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22334208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64223340Medicaid
KYP00321310OtherRAILROAD MEDCARE KY
KY0999501Medicare PIN