Provider Demographics
NPI:1447459417
Name:SAM F. YARED, PLLC
Entity type:Organization
Organization Name:SAM F. YARED, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISSAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:YARED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-426-7761
Mailing Address - Street 1:1408 HADLEIGH PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5651
Mailing Address - Country:US
Mailing Address - Phone:502-814-3184
Mailing Address - Fax:502-426-8272
Practice Address - Street 1:2355 POPLAR LEVEL RD
Practice Address - Street 2:SUITE 305
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1395
Practice Address - Country:US
Practice Address - Phone:502-634-0072
Practice Address - Fax:502-636-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22334208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYD92437OtherUPIN
KY64223340Medicaid
KYD92437OtherUPIN