Provider Demographics
NPI:1972527794
Name:SAJADI, KOOROS (MD)
Entity type:Individual
Prefix:
First Name:KOOROS
Middle Name:
Last Name:SAJADI
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 1:230 FOUNTAIN CT
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1895
Mailing Address - Country:US
Mailing Address - Phone:859-276-5008
Mailing Address - Fax:859-278-6401
Practice Address - Street 1:230 FOUNTAIN CT
Practice Address - Street 2:SUITE 180
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1895
Practice Address - Country:US
Practice Address - Phone:859-276-5008
Practice Address - Fax:859-278-6401
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19960207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY201769676OtherRAILROAD MEDICARE
KY64-199607Medicaid
KYP400016428Medicare PIN
KY201769676OtherRAILROAD MEDICARE