Liberty Wellcare, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

37821 Issued in KY

Legal business name

LIBERTY WELLCARE, PLLC

Practice address

216 Bluffwood Dr
Danville, KY 40422-9788

Phone

(859) 238-7756

Fax

(270) 378-5786

NPI assigned

Apr 22, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Imad A Haddad, MD

Title

Ceo

Phone

(859) 238-7756

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366588800000",
    "number": "1134563125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 BLUFFWOOD DR",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404229788",
            "telephone_number": "859-238-7756",
            "fax_number": "270-378-5786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 BLUFFWOOD DR",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404229788",
            "telephone_number": "859-238-7756",
            "fax_number": "270-378-5786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY WELLCARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-22",
        "last_updated": "2013-04-22",
        "status": "A",
        "authorized_official_last_name": "HADDAD",
        "authorized_official_first_name": "IMAD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "859-238-7756",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "KY",
            "license": "37821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64065865",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Danville, KY
• Providers in Danville, KY by specialty
• Internal Medicine Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.