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General NPI Number Information
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NPI Number | 1093833998
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Entity Type | Organization
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Legal Business Name | KFOURY MEDICAL SPECIALISTS PLLC
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 1 TRILLIUM WAY
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City | CORBIN
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State | KY
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Zip | 40701-8727
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Country | US
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Telephone | 606-309-1806
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Fax | 606-657-5734
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Provider Business Mailing Address
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Address Line | PO BOX 2828
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City | LONDON
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State | KY
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Zip | 40743-2828
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Country | US
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Telephone | 606-309-1806
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Fax | 606-657-5734
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Authorized Official
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Title or Position | OWNER AND MEMBER
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Name | WAJDI S KFOURY
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Credential | MD
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Telephone | 606-309-1806
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 38881
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License Number State | KY
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