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NPI 1902348543

NPI 1902348543 : CHRISTOPHER CILIBERTO MGC : LOUISVILLE, KY

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General NPI Number Information
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    NPI Number           |    1902348543
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    Entity Type          |    Individual 
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    Provider Name        |    CHRISTOPHER CILIBERTO MGC
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    11/14/2016
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    Last Update Date     |    10/13/2020
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Provider Practice Location Address
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    Address Line         |    411 E CHESTNUT ST 
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    City                 |    LOUISVILLE
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    State                |    KY
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    Zip                  |    40202
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    Country              |    US
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    Telephone            |    502-588-0850
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    Fax                  |    502-588-9534
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Provider Business Mailing Address
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    Address Line         |    PO BOX 909 
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    City                 |    LOUISVILLE
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    State                |    KY
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    Zip                  |    40201-0909
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    Country              |    US
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    Telephone            |    502-588-0850
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    Fax                  |    502-588-9534
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    170300000X
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    Taxonomy Name        |    Genetic Counselor (M.S.)
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    License Number       |    
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    License Number State |    
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