Provider Demographics
NPI:1174595300
Name:ELMALLAKH, RIFAAT S (MD)
Entity type:Individual
Prefix:
First Name:RIFAAT
Middle Name:S
Last Name:ELMALLAKH
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:P.O. BOX 69
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201
Mailing Address - Country:US
Mailing Address - Phone:502-852-5866
Mailing Address - Fax:502-852-5096
Practice Address - Street 1:550 S. JACKSON ST.
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-5866
Practice Address - Fax:502-852-5098
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY292992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64092992Medicaid
0060268Medicare PIN
KYF66914Medicare UPIN
F66914Medicare UPIN
KY64092992Medicaid