Healthcare Provider Details

I. General information

NPI: 1447282249
Provider Name (Legal Business Name): CENTRAL KENTUCKY PLASTIC SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W MAIN ST STE 101
DANVILLE KY
40422-1871
US

IV. Provider business mailing address

230 W MAIN ST STE 101
DANVILLE KY
40422-1871
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-1670
  • Fax: 859-236-1672
Mailing address:
  • Phone: 859-236-1670
  • Fax: 859-236-1672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER A. MAREK
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 859-236-1670