Healthcare Provider Details

I. General information

NPI: 1265454334
Provider Name (Legal Business Name): TAYYEB M AYYOUBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S JACKSON ST
LOUISVILLE KY
40202-1675
US

IV. Provider business mailing address

530 S JACKSON ST
LOUISVILLE KY
40202-1675
US

V. Phone/Fax

Practice location:
  • Phone: 502-425-6845
  • Fax:
Mailing address:
  • Phone: 502-588-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number9890
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number43194
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: