Healthcare Provider Details

I. General information

NPI: 1568551042
Provider Name (Legal Business Name): GAMAL F MONEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 KRESGE WAY
LOUISVILLE KY
40207-4605
US

IV. Provider business mailing address

2600 STANLEY GAULT PARKWAY SUITE 201
LOUISVILLE KY
40223
US

V. Phone/Fax

Practice location:
  • Phone: 502-897-8100
  • Fax:
Mailing address:
  • Phone: 502-238-2801
  • Fax: 502-238-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31840
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number31840
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: