Provider Demographics
NPI:1972539450
Name:INTERNAL MEDICINE AND PEDIATRIC ASSOCIATES, PSC
Entity type:Organization
Organization Name:INTERNAL MEDICINE AND PEDIATRIC ASSOCIATES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:G
Authorized Official - Last Name:KAREM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-241-6567
Mailing Address - Street 1:7101 W HWY 22
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014
Mailing Address - Country:US
Mailing Address - Phone:502-241-6567
Mailing Address - Fax:502-241-5083
Practice Address - Street 1:7101 W HWY 22
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014
Practice Address - Country:US
Practice Address - Phone:502-241-6567
Practice Address - Fax:502-241-5083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28815207R00000X
KY31336207R00000X
KY32484208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5343Medicare PIN