Healthcare Provider Details

I. General information

NPI: 1073539847
Provider Name (Legal Business Name): TOMASZ KOBYLANSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8019 DIXIE HWY STE 101
LOUISVILLE KY
40258-1303
US

IV. Provider business mailing address

8019 DIXIE HWY STE 101
LOUISVILLE KY
40258-1303
US

V. Phone/Fax

Practice location:
  • Phone: 502-333-3121
  • Fax: 502-531-9538
Mailing address:
  • Phone: 502-333-3121
  • Fax: 502-531-9538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01058945A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number37572
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: