Healthcare Provider Details

I. General information

NPI: 1720064314
Provider Name (Legal Business Name): MARTIN THOMAS KLAUS PREEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 FINANCIAL PL SUITE 100
ELIZABETHTOWN KY
42701-4470
US

IV. Provider business mailing address

103 FINANCIAL PL SUITE 100
ELIZABETHTOWN KY
42701-4470
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-0110
  • Fax:
Mailing address:
  • Phone: 270-769-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number03145
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: