Healthcare Provider Details

I. General information

NPI: 1023281052
Provider Name (Legal Business Name): SHRI K VAISH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3217 LINVILLE LN
LEXINGTON KY
40513-1247
US

IV. Provider business mailing address

3217 LINVILLE LN
LEXINGTON KY
40513-1247
US

V. Phone/Fax

Practice location:
  • Phone: 937-270-4295
  • Fax:
Mailing address:
  • Phone: 937-270-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number061364
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number42472
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number061364
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number43472
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: