1649265059 NPI number — MEHDI POORKAY M.D.

Table of content: MEHDI POORKAY M.D. (NPI 1649265059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649265059 NPI number — MEHDI POORKAY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POORKAY
Provider First Name:
MEHDI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649265059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/23/2006
NPI Reactivation Date:
04/04/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-559-9407
Provider Business Mailing Address Fax Number:
502-272-5339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 E GRAY ST STE 605
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-559-3636
Provider Business Practice Location Address Fax Number:
502-629-5442
Provider Enumeration Date:
09/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  35245 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 35245 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RE0101X , with the licence number: 35245 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50019378 . This is a "PASSPORT- NORTON INPATIENT SPECIALISTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 00533027 . This is a "MEDICARE- NORTON COMMUNITY MEDICAL ASSOCIATES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50026914 . This is a "PASSPORT- NORTON COMMUNITY MEDICAL ASSOCIATES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P00278628 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023032U . This is a "HUMANA- NORTON COMMUNITY MEDICAL ASSOCIATES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 094640 . This is a "SIHO- NORTON COMMUNITY MEDICAL ASSOCIATES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000023032U . This is a "HUMANA- NORTON INPATIENT SPECIALISTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3754970000 . This is a "PASSPORT ADVANTAGE- NORTON COMMUNITY MEDICAL ASSOCIATES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4601699 . This is a "CIGNA- N. INPATIENT SPECIALISTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000639505 . This is a "ANTHEM- NORTON COMMUNITY MEDICAL ASSOCIATES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 00533027 . This is a "MEDICARE- NORTON INPATIENT SPECIALISTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200812020 . This is a "ANTHEM INDIANA MEDICAID- NORTON COMMUNITY MEDICAL ASSOCIATES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200812020 . This is a "MEDICAID INDIANA- NORTON INPATIENT SPECIALISTS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64008535 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3527401000 . This is a "PASSPORT ADVANTAGE- NIS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 200812020 . This is a "MANAGED HEALTH SERVICES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4601699 . This is a "CIGNA- NORTON COMMUNITY MEDICAL ASSOCIATES" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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