Healthcare Provider Details

I. General information

NPI: 1053579433
Provider Name (Legal Business Name): ROY KIRIAKOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 LEAWOOD DR
FRANKFORT KY
40601-3349
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI GARDENS FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 502-227-7188
  • Fax: 502-227-7379
Mailing address:
  • Phone: 502-775-1211
  • Fax: 502-398-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036120955
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number46169
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46169
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: