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General NPI Number Information
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NPI Number | 1821250622
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Entity Type | Organization
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Legal Business Name | KENNETH J.S.DESIMONE.,M.D.,F.A.C.S.,P.L.L.C.
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 704 COLUMBIA HWY
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City | GREENSBURG
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State | KY
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Zip | 42743-1118
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Country | US
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Telephone | 270-932-4203
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Fax | 270-932-7019
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Provider Business Mailing Address
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Address Line | PO BOX 180
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City | GREENSBURG
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State | KY
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Zip | 42743-0180
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Country | US
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Telephone | 270-932-4203
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Fax | 270-932-7019
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Authorized Official
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Title or Position | SOLE OWNER
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Name | DR. KENNETH J.S. DESIMONE
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Credential | M.D.
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Telephone | 270-932-4203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 11774
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License Number State | KY
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