Healthcare Provider Details

I. General information

NPI: 1811962350
Provider Name (Legal Business Name): HISHAM A ALREFAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 PARK PLAZA AVE UNIT 104
LOUISVILLE KY
40241-2289
US

IV. Provider business mailing address

9720 PARK PLAZA AVE UNIT 104
LOUISVILLE KY
40241-2289
US

V. Phone/Fax

Practice location:
  • Phone: 502-895-8218
  • Fax: 502-895-8219
Mailing address:
  • Phone: 502-895-8218
  • Fax: 502-895-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01055359A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number37214
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: