Healthcare Provider Details

I. General information

NPI: 1073858668
Provider Name (Legal Business Name): ADRIAN G THODOROPOULOS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 LONE OAK RD
PADUCAH KY
42003-7901
US

IV. Provider business mailing address

1530 LONE OAK RD
PADUCAH KY
42003-7901
US

V. Phone/Fax

Practice location:
  • Phone: 270-444-2444
  • Fax:
Mailing address:
  • Phone: 270-444-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3007876
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: