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General NPI Number Information
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NPI Number | 1437294386
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Entity Type | Individual
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Provider Name | SHERVIN R DASHTI M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 01/12/2021
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Provider Practice Location Address
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Address Line | 210 E GRAY ST STE 1105
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City | LOUISVILLE
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State | KY
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Zip | 40202-3907
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Country | US
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Telephone | 502-583-1697
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Fax | 502-583-2120
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Provider Business Mailing Address
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Address Line | PO BOX 776351
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City | CHICAGO
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State | IL
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Zip | 60677-6351
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | 42812
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License Number State | KY
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