Healthcare Provider Details

I. General information

NPI: 1104384536
Provider Name (Legal Business Name): KOLIGO SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S FLOYD ST
LOUISVILLE KY
40202-1208
US

IV. Provider business mailing address

204 S FLOYD ST
LOUISVILLE KY
40202-1208
US

V. Phone/Fax

Practice location:
  • Phone: 502-292-9967
  • Fax:
Mailing address:
  • Phone: 502-292-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL G HUGHES
Title or Position: OWNER
Credential: MD
Phone: 502-292-9967