MEDICARE: DR. TAYEBA MINHAS IKRAM D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9880	KY

General Provider Information

NPI Number	:	1952841017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAYEBA MINHAS IKRAM D.M.D.

Provider Business Mailing Address
First Line	:	2003 ASHFORD DR
Second Line	:
City	:	GOSHEN
State	:	KY
Zip	:	40026-8424
Country	:	US
Telephone Number	:	812-989-3459
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 STONECREST CT
Second Line	:	SUITE NUMBER 200
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8155
Country	:	US
Telephone Number	:	502-633-1819
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2017
Last Update Date	:	03/07/2017

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