Provider Demographics
NPI:1609980648
Name:ADDAS, MOUHAMAD (MD)
Entity type:Individual
Prefix:DR
First Name:MOUHAMAD
Middle Name:
Last Name:ADDAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22787
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-0787
Mailing Address - Country:US
Mailing Address - Phone:513-560-5113
Mailing Address - Fax:
Practice Address - Street 1:5107 CRAIGS CREEK DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-4863
Practice Address - Country:US
Practice Address - Phone:513-560-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39915208M00000X
IN01061288A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7663783OtherAETNA
IN262180AMedicare PIN
KY01039002Medicare PIN