Healthcare Provider Details

I. General information

NPI: 1285657585
Provider Name (Legal Business Name): GREGORY JOHN CILIBERTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9517 US HIGHWAY 42
PROSPECT KY
40059-9237
US

IV. Provider business mailing address

9517 US HIGHWAY 42
PROSPECT KY
40059-9237
US

V. Phone/Fax

Practice location:
  • Phone: 502-587-0521
  • Fax: 502-587-3894
Mailing address:
  • Phone: 502-587-0521
  • Fax: 502-587-3894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24106
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: