=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851362040
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL R KENSICKI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2006
-----------------------------------------------------
Last Update Date | 03/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 S JACKSON ST
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40202-1622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-852-1931
-----------------------------------------------------
Fax | 502-852-5098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3367
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40201-3367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-813-6655
-----------------------------------------------------
Fax | 502-813-6665
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 33805
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------