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General NPI Number Information
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NPI Number | 1184789364
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Entity Type | Organization
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Legal Business Name | PEDIATRIC SPECIALISTS LLC
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 505 KLUTEY PARK PLAZA DR
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City | HENDERSON
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State | KY
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Zip | 42420-5224
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Country | US
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Telephone | 270-830-0313
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Fax | 270-830-7117
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Provider Business Mailing Address
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Address Line | 505 KLUTEY PARK PLAZA DR
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City | HENDERSON
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State | KY
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Zip | 42420-5224
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Country | US
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Telephone | 270-830-0313
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Fax | 270-830-7117
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Authorized Official
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Title or Position | PRESTIDENT
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Name | DR. IYAD ALJABI
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Credential | MD
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Telephone | 270-830-0313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 27411
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 27410
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License Number State | KY
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