Healthcare Provider Details

I. General information

NPI: 1790895159
Provider Name (Legal Business Name): HICHAM TARIK ABADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST HX319D
LEXINGTON KY
40536-0293
US

IV. Provider business mailing address

800 ROSE ST HX319D
LEXINGTON KY
40536-0293
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5069
  • Fax: 859-257-4457
Mailing address:
  • Phone: 859-323-5069
  • Fax: 859-257-4457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberSP182
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberSP182
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberFL032
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberFL032
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: