Healthcare Provider Details

I. General information

NPI: 1184789364
Provider Name (Legal Business Name): PEDIATRIC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 KLUTEY PARK PLAZA DR
HENDERSON KY
42420-5224
US

IV. Provider business mailing address

505 KLUTEY PARK PLAZA DR
HENDERSON KY
42420-5224
US

V. Phone/Fax

Practice location:
  • Phone: 270-830-0313
  • Fax: 270-830-7117
Mailing address:
  • Phone: 270-830-0313
  • Fax: 270-830-7117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number27411
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number27410
License Number StateKY

VIII. Authorized Official

Name: DR. IYAD ALJABI
Title or Position: PRESTIDENT
Credential: MD
Phone: 270-830-0313