Healthcare Provider Details

I. General information

NPI: 1154882561
Provider Name (Legal Business Name): HARSIMRAN SINGH BRAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S JACKSON ST STE A3K00
LOUISVILLE KY
40202-1622
US

IV. Provider business mailing address

550 S JACKSON ST STE A3R40
LOUISVILLE KY
40202-1622
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5666
  • Fax: 502-852-8980
Mailing address:
  • Phone: 502-852-5841
  • Fax: 502-852-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number56725
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number56725
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: