Healthcare Provider Details

I. General information

NPI: 1992753727
Provider Name (Legal Business Name): KISHOR N VORA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BRECKENRIDGE ST
OWENSBORO KY
42303-1090
US

IV. Provider business mailing address

1200 BRECKENRIDGE ST
OWENSBORO KY
42303-1090
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-8672
  • Fax: 270-685-8223
Mailing address:
  • Phone: 270-684-0028
  • Fax: 270-685-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number28753
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number28753
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: