MEDICARE: AFTAB SHAKIR CHISHTI 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	2080P0210X	Pediatric Nephrology Physician	TP843	KY
2	2080P0210X	Pediatric Nephrology Physician	41863	KY

General Provider Information

NPI Number	:	1619144474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFTAB SHAKIR CHISHTI MD

Provider Business Mailing Address
First Line	:	2333 ALUMNI PARK PLZ
Second Line	:	SUITE 200
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4012
Country	:	US
Telephone Number	:	859-218-5677
Fax Number	:	859-257-7899

Provider Business Practice Location Address
First Line	:	740 S LIMESTONE ST
Second Line	:	ROOM J460
City	:	LEXINGTON
State	:	KY
Zip	:	40536-0001
Country	:	US
Telephone Number	:	859-323-5481
Fax Number	:	859-257-7706

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

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	08/10/2015

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