Provider Demographics
NPI:1902036825
Name:KENTUCKIANA GERIATRIC AND PALLIATIVE SERVICES PLLC
Entity Type:Organization
Organization Name:KENTUCKIANA GERIATRIC AND PALLIATIVE SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BABAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-544-8293
Mailing Address - Street 1:PO BOX 8133
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40257-8133
Mailing Address - Country:US
Mailing Address - Phone:502-544-8293
Mailing Address - Fax:
Practice Address - Street 1:1877 FARNSLEY RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4701
Practice Address - Country:US
Practice Address - Phone:502-797-4236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RG0300X, 207RH0002X, 363LA2200X, 363LF0000X
KY363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100255800Medicaid
IN201003780AMedicaid
KY7100265630Medicaid
INM100030118Medicare PIN