Healthcare Provider Details

I. General information

NPI: 1295886596
Provider Name (Legal Business Name): ABDOLKARIM TAHANASAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PHYSICIANS PARK
FRANKFORT KY
40601-4108
US

IV. Provider business mailing address

6 PHYSICIANS PARK
FRANKFORT KY
40601-4108
US

V. Phone/Fax

Practice location:
  • Phone: 502-875-1559
  • Fax:
Mailing address:
  • Phone: 502-875-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17210
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: