Healthcare Provider Details

I. General information

NPI: 1770549537
Provider Name (Legal Business Name): GEORGE V. KALAYIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CHESTNUT ST SUITE 600
LOUISVILLE KY
40202-5700
US

IV. Provider business mailing address

401 E CHESTNUT ST SUITE 610
LOUISVILLE KY
40202-5700
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-4425
  • Fax: 502-588-4427
Mailing address:
  • Phone: 502-588-4450
  • Fax: 502-588-9539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036114085
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number47520
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: