Provider Demographics
NPI:1730252453
Name:HAQ, AKASHA (MD)
Entity type:Individual
Prefix:
First Name:AKASHA
Middle Name:
Last Name:HAQ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AKASHA
Other - Middle Name:AMAN
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-587-0394
Mailing Address - Fax:502-587-0390
Practice Address - Street 1:1850 BLUEGRASS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1161
Practice Address - Country:US
Practice Address - Phone:502-367-3360
Practice Address - Fax:502-367-3365
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64056401Medicaid
KY01243001OtherMEDICARE
KY64056401Medicaid