Healthcare Provider Details

I. General information

NPI: 1215663521
Provider Name (Legal Business Name): AHMED AL HARBI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ABRAHAM FLEXNER WAY STE 850
LOUISVILLE KY
40202-3840
US

IV. Provider business mailing address

225 ABRAHAM FLEXNER WAY STE 850
LOUISVILLE KY
40202-3840
US

V. Phone/Fax

Practice location:
  • Phone: 502-562-0312
  • Fax:
Mailing address:
  • Phone: 502-562-0312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberFT648
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: