Healthcare Provider Details

I. General information

NPI: 1972539450
Provider Name (Legal Business Name): INTERNAL MEDICINE AND PEDIATRIC ASSOCIATES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 W HWY 22
CRESTWOOD KY
40014
US

IV. Provider business mailing address

7101 W HWY 22
CRESTWOOD KY
40014
US

V. Phone/Fax

Practice location:
  • Phone: 502-241-6567
  • Fax: 502-241-5083
Mailing address:
  • Phone: 502-241-6567
  • Fax: 502-241-5083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number31336
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32484
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28815
License Number StateKY

VIII. Authorized Official

Name: DR. ANTHONY G KAREM
Title or Position: PRESIDENT
Credential: MD
Phone: 502-241-6567