Healthcare Provider Details

I. General information

NPI: 1083185938
Provider Name (Legal Business Name): KENTUCKY ORTHOPAEDICS & SPINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 SHOPPERS DR
WINCHESTER KY
40391-1378
US

IV. Provider business mailing address

404 SHOPPERS DR
WINCHESTER KY
40391-1378
US

V. Phone/Fax

Practice location:
  • Phone: 859-737-5333
  • Fax: 859-737-0070
Mailing address:
  • Phone: 859-737-5333
  • Fax: 859-737-0070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: GREGORY F GRAU
Title or Position: SR PARTNER
Credential: MD
Phone: 859-737-5333