Healthcare Provider Details

I. General information

NPI: 1083940076
Provider Name (Legal Business Name): OSIAS M VILLAFLOR, MD, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 CONCRETE RD
CARLISLE KY
40311-9721
US

IV. Provider business mailing address

2300 CONCRETE RD
CARLISLE KY
40311-9721
US

V. Phone/Fax

Practice location:
  • Phone: 859-289-2651
  • Fax: 859-289-2351
Mailing address:
  • Phone: 859-289-2651
  • Fax: 859-289-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21730
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21730
License Number StateKY

VIII. Authorized Official

Name: DR. OSIAS M VILLAFLOR
Title or Position: PRESIDENT
Credential: MD
Phone: 859-289-2651