Healthcare Provider Details

I. General information

NPI: 1912151374
Provider Name (Legal Business Name): SHAISTA TARIQ ARAIN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 S LIMESTONEST KENTUCKY CLINIC J-403
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

202 BARTRAM CT
WINCHESTER KY
40391-9340
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6211
  • Fax:
Mailing address:
  • Phone: 859-403-0069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43523
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: