MEDICARE: AJITH NAIR 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	174400000X	Specialist	36217	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1073515227	OTHER	KY	MEDICARE NPI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073515227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJITH NAIR MD

Provider Business Mailing Address
First Line	:	PO BOX 24261
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40224-0261
Country	:	US
Telephone Number	:	502-995-4004
Fax Number	:	502-933-5559

Provider Business Practice Location Address
First Line	:	3710 CHAMBERLAIN LN
Second Line	:	STE A
City	:	LOUISVILLE
State	:	KY
Zip	:	40241
Country	:	US
Telephone Number	:	502-995-4004
Fax Number	:	502-933-5559

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/02/2018

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Directions to “ AJITH NAIR MD” Practice Location

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