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General NPI Number Information
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NPI Number | 1962489559
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Entity Type | Individual
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Provider Name | ZHALET BAHARESTAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 3920 DUTCHMANS LN SUITE 305
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City | LOUISVILLE
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State | KY
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Zip | 40207-4702
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Country | US
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Telephone | 502-899-4177
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Fax | 502-259-6900
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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 | 502-899-4177
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Fax | 502-259-6900
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | KY02786
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License Number State | KY
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