Healthcare Provider Details

I. General information

NPI: 1447459417
Provider Name (Legal Business Name): SAM F. YARED, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 POPLAR LEVEL RD SUITE 305
LOUISVILLE KY
40217-1395
US

IV. Provider business mailing address

1408 HADLEIGH PL
LOUISVILLE KY
40222-5651
US

V. Phone/Fax

Practice location:
  • Phone: 502-634-0072
  • Fax: 502-636-7130
Mailing address:
  • Phone: 502-814-3184
  • Fax: 502-426-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number22334
License Number StateKY

VIII. Authorized Official

Name: DR. ISSAM F YARED
Title or Position: OWNER
Credential: MD
Phone: 502-426-7761