Healthcare Provider Details

I. General information

NPI: 1932428166
Provider Name (Legal Business Name): HABIB SROUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE STREET
LEXINGTON KY
40505
US

IV. Provider business mailing address

800 ROSE STREET N202 UKMC ANESTHESIOLOGY
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5956
  • Fax: 859-323-1080
Mailing address:
  • Phone: 859-323-5956
  • Fax: 937-500-5329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number47564
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number47564
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: