Provider Demographics
NPI:1205341542
Name:ADVANCED CENTER FOR ARTHRITIS & OSTEOPOROSIS KENTUCKY,PLLC
Entity type:Organization
Organization Name:ADVANCED CENTER FOR ARTHRITIS & OSTEOPOROSIS KENTUCKY,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAWARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-278-2575
Mailing Address - Street 1:3210 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1950
Mailing Address - Country:US
Mailing Address - Phone:859-278-2575
Mailing Address - Fax:859-277-1843
Practice Address - Street 1:3284 EAGLE VIEW LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1851
Practice Address - Country:US
Practice Address - Phone:859-278-2575
Practice Address - Fax:859-277-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47166207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty