Healthcare Provider Details

I. General information

NPI: 1972240638
Provider Name (Legal Business Name): MR. KENNETH ARACHIKAVITZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2022
Last Update Date: 05/15/2022
Certification Date: 05/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S 4TH ST
LOUISVILLE KY
40203-3205
US

IV. Provider business mailing address

13206 MEADOWLAWN DR
LOUISVILLE KY
40272-1736
US

V. Phone/Fax

Practice location:
  • Phone: 502-585-9911
  • Fax:
Mailing address:
  • Phone: 502-594-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: