Healthcare Provider Details

I. General information

NPI: 1609880301
Provider Name (Legal Business Name): EAST END INFECTIOUS DISEASE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 RIVER RD #300
LOUISVILLE KY
40206-2093
US

IV. Provider business mailing address

2301 RIVER RD #300
LOUISVILLE KY
40206-2093
US

V. Phone/Fax

Practice location:
  • Phone: 502-814-3171
  • Fax:
Mailing address:
  • Phone: 502-814-3171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number34625
License Number StateKY

VIII. Authorized Official

Name: KAMRAN AKHTAR
Title or Position: OWNER
Credential: MD
Phone: 502-814-3171