Healthcare Provider Details

I. General information

NPI: 1679599500
Provider Name (Legal Business Name): KAMLESH C DAVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 NEW MOODY LN
LAGRANGE KY
40031-9122
US

IV. Provider business mailing address

PO BOX 473
LA GRANGE KY
40031-0473
US

V. Phone/Fax

Practice location:
  • Phone: 502-222-0028
  • Fax: 502-222-0029
Mailing address:
  • Phone: 502-693-2465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34317
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: