Healthcare Provider Details

I. General information

NPI: 1194874586
Provider Name (Legal Business Name): PAUL JOHN CILIBERTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306C MIDDLETOWN PARK PLACE
LOUISVILLE KY
40243
US

IV. Provider business mailing address

306C MIDDLETOWN PARK PLACE
LOUISVILLE KY
40243
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-2661
  • Fax: 502-245-2668
Mailing address:
  • Phone: 502-245-2661
  • Fax: 502-245-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19741
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: