MEDICARE: MAHA BOTROS MIKHAIL WASSEF MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	036126126	IL
2	207RC0000X	Cardiovascular Disease Physician	0101240731	VA
3	207RC0000X	Cardiovascular Disease Physician	TP865	KY
4	207RC0000X	Cardiovascular Disease Physician	ME132417	FL
5	207UN0901X	Nuclear Cardiology Physician	040740	CT
6	207UN0901X	Nuclear Cardiology Physician	0101240731	VA
7	207RC0000X	Cardiovascular Disease Physician	040740	CT
8	207RC0000X	Cardiovascular Disease Physician	25MA08180200	NJ
9	207UN0901X	Nuclear Cardiology Physician	25MA08181200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W0001	OTHER	FL	HFMG
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063511095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHA BOTROS MIKHAIL WASSEF MD

Provider Business Mailing Address
First Line	:	PO BOX 950248
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0248
Country	:	US
Telephone Number	:	502-489-5730
Fax Number	:	502-489-5753

Provider Business Practice Location Address
First Line	:	4003 KRESGE WAY
Second Line	:	SUITE 221
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4652
Country	:	US
Telephone Number	:	502-897-7107
Fax Number	:	502-897-7613

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	03/09/2026

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