Healthcare Provider Details

I. General information

NPI: 1770783995
Provider Name (Legal Business Name): DHOLAKIA AND ASSOCIATES, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 07/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 CUMBERLAND AVE
MIDDLESBORO KY
40965-2834
US

IV. Provider business mailing address

2315 CUMBERLAND AVE
MIDDLESBORO KY
40965-2834
US

V. Phone/Fax

Practice location:
  • Phone: 606-248-0507
  • Fax: 606-248-2030
Mailing address:
  • Phone: 606-248-0508
  • Fax: 606-248-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number23755
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23759
License Number StateKY

VIII. Authorized Official

Name: DR. SATISH V DHOLAKIA
Title or Position: PRESIDENT
Credential: MD
Phone: 606-248-0507