Healthcare Provider Details

I. General information

NPI: 1285037812
Provider Name (Legal Business Name): HISHAM A ALREFAI MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2014
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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: HISHAM A ALREFAI
Title or Position: OWNER
Credential: MD
Phone: 502-895-8218