Healthcare Provider Details

I. General information

NPI: 1023100849
Provider Name (Legal Business Name): VRATISLAV V KEJZLAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 JAMES SANDERS BLVD SUITE A
PADUCAH KY
42001-8405
US

IV. Provider business mailing address

2725 JAMES SANDERS BLVD SUITE A
PADUCAH KY
42001-8405
US

V. Phone/Fax

Practice location:
  • Phone: 270-554-5114
  • Fax: 270-554-5021
Mailing address:
  • Phone: 270-554-5114
  • Fax: 270-554-5021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number23680
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: