Healthcare Provider Details

I. General information

NPI: 1558602110
Provider Name (Legal Business Name): KENTUCKY DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 NEW L AGRANGE ROAD SUITE 207
LOUISVILLE KY
40222
US

IV. Provider business mailing address

7321 NEW LAGRANGE ROAD SUITE 207
LOUISVILLE KY
40222
US

V. Phone/Fax

Practice location:
  • Phone: 800-431-3235
  • Fax: 800-431-3235
Mailing address:
  • Phone: 800-431-3235
  • Fax: 800-431-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT AGUILAR
Title or Position: PRESIDENT
Credential: M.S.
Phone: 800-431-3235