Healthcare Provider Details

I. General information

NPI: 1710321963
Provider Name (Legal Business Name): CAITLIN FIORILLO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 SOUTH LIMESTONE C300
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

800 ROSE ST C236
LEXINGTON KY
40536-0001
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-5405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number52899
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number52899
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: