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General NPI Number Information
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NPI Number | 1669409702
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Entity Type | Individual
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Provider Name | AJMAL H BANGASH MD
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Gender | Male
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 1850 BLUEGRASS AVE
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City | LOUISVILLE
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State | KY
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Zip | 40215-1161
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Country | US
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Telephone | 502-895-2902
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Fax | 502-893-8867
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Provider Business Mailing Address
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Address Line | 100 E LIBERTY ST SUITE 800
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City | LOUISVILLE
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State | KY
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Zip | 40202-1434
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Country | US
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Telephone | 502-357-1039
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Fax |
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | K5794
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 37006
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01069859A
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License Number State | IN
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