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General NPI Number Information
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NPI Number | 1649289588
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Entity Type | Organization
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Legal Business Name | THE BARIATRIC INSTITUE OF KENTUCKY
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 125 E MAXWELL ST SUITE 201
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City | LEXINGTON
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State | KY
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Zip | 40508-2678
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Country | US
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Telephone | 859-233-0572
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Fax | 859-233-0651
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Provider Business Mailing Address
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Address Line | 870 CORPORATE DR SUITE 400
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City | LEXINGTON
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State | KY
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Zip | 40503-5416
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Country | US
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Telephone | 859-277-9436
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Fax | 859-277-1765
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDALL BOLAR
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Credential | MD
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Telephone | 859-233-0572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 35317
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License Number State | KY
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