Facts
- Status
- A
- Credential
- M.D.
- Type
- Individual
- Enumeration date
- 2006-05-31
- Last updated
- 2018-09-07
Specialties
Licenses
- License KY
- 23828
Location
- Practice location
- 119 FAIRFIELD AVE, SUITE R102
- City
- BELLEVUE KY
- Postal code
- 41073
- Phone
- 859-431-0090
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.