Healthcare Provider Details

I. General information

NPI: 1184640674
Provider Name (Legal Business Name): ALEXANDER GEORGE DIGENIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E BROADWAY SUITE 1100 NORTON HEALTHCARE PAVILION
LOUISVILLE KY
40202
US

IV. Provider business mailing address

PO BOX 1027
LOUISVILLE KY
40201
US

V. Phone/Fax

Practice location:
  • Phone: 502-589-5544
  • Fax: 502-561-0040
Mailing address:
  • Phone: 502-589-5544
  • Fax: 502-561-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number28381KY
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: