Healthcare Provider Details

I. General information

NPI: 1740255314
Provider Name (Legal Business Name): AVICHAI ERES MD FACC FSCAI FSVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 N EAGLE CREEK DR SUITE 400
LEXINGTON KY
40509-9038
US

IV. Provider business mailing address

161 N EAGLE CREEK DR SUITE 400
LEXINGTON KY
40509-9038
US

V. Phone/Fax

Practice location:
  • Phone: 859-226-0031
  • Fax: 859-226-0041
Mailing address:
  • Phone: 859-226-0031
  • Fax: 859-226-0041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number27415
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: