Healthcare Provider Details

I. General information

NPI: 1548319593
Provider Name (Legal Business Name): YASIR SAIFULLAH MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 FINANCIAL DRIVE SUITE 100
ELIZABETHTOWN KY
42701
US

IV. Provider business mailing address

103 FINANCIAL DRIVE SUITE 100
ELIZABETHTOWN KY
42701
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-0110
  • Fax: 270-765-6953
Mailing address:
  • Phone: 270-769-0110
  • Fax: 270-765-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YASIR SAIFULLAH
Title or Position: OWNER
Credential: M.D.
Phone: 270-769-0110