Healthcare Provider Details

I. General information

NPI: 1124009659
Provider Name (Legal Business Name): ABDI VAEZY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14949 N US HIGHWAY 25 E SUITE 6
CORBIN KY
40701-6285
US

IV. Provider business mailing address

PO BOX 1325
CORBIN KY
40702-1325
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-0009
  • Fax: 606-528-0091
Mailing address:
  • Phone: 606-526-8131
  • Fax: 606-528-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25857
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: