Healthcare Provider Details

I. General information

NPI: 1275547606
Provider Name (Legal Business Name): KENTUCKY FERTILITY AND GYNECOLOGY, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3292 EAGLE VIEW LN STE 190
LEXINGTON KY
40509-2173
US

IV. Provider business mailing address

PO BOX 55069
LEXINGTON KY
40555-5069
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-5736
  • Fax: 859-276-2236
Mailing address:
  • Phone: 859-277-5736
  • Fax: 859-276-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA779
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number02485
License Number StateKY

VIII. Authorized Official

Name: GEORGE MICHAEL VELOUDIS JR.
Title or Position: OWNER
Credential: DO
Phone: 859-277-5736