Healthcare Provider Details

I. General information

NPI: 1093833998
Provider Name (Legal Business Name): KFOURY MEDICAL SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRILLIUM WAY
CORBIN KY
40701-8727
US

IV. Provider business mailing address

PO BOX 2828
LONDON KY
40743-2828
US

V. Phone/Fax

Practice location:
  • Phone: 606-309-1806
  • Fax: 606-657-5734
Mailing address:
  • Phone: 606-309-1806
  • Fax: 606-657-5734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number38881
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WAJDI S KFOURY
Title or Position: OWNER AND MEMBER
Credential: MD
Phone: 606-309-1806