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NPI Code Detail

MEDICARE: PROSPERO ISHKANIAN MD PSC

MEDICARE: PROSPERO ISHKANIAN MD PSC
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1851510846
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROSPERO ISHKANIAN MD PSC
Provider Business Mailing Address
First Line : 7101 WESBORO RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40222-6453
Country : US
Telephone Number : 502-560-1326
Fax Number : 502-560-1327
Provider Business Practice Location Address
First Line : 1313 SAINT ANTHONY PL
Second Line :
City : LOUISVILLE
State : KY
Zip : 40204-1740
Country : US
Telephone Number : 502-560-1326
Fax Number : 502-560-1327
Authorized Official
Title or Position : DOCTOR
Name : DR. PROSPERO ISHKANIAN
Credential : MD
Telephone Number : 502-560-1326
Provider Enumeration Date : 04/25/2007
Last Update Date : 07/25/2008

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Directions to “PROSPERO ISHKANIAN MD PSC ” Practice Location

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