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General NPI Number Information
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NPI Number | 1922726371
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Entity Type | Organization
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Legal Business Name | CARECONNECTMD KENTUCKY PSC
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 312 S 4TH ST STE 700
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City | LOUISVILLE
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State | KY
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Zip | 40202-3046
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Country | US
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Telephone | 888-789-9585
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Fax | 562-809-4500
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Provider Business Mailing Address
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Address Line | 3090 BRISTOL ST STE 200
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City | COSTA MESA
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State | CA
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Zip | 92626-3061
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Country | US
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Telephone | 888-748-9958
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Fax | 562-803-4500
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Authorized Official
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Title or Position | OWNER
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Name | DR. ORLANDO ACOSTA COLLADO
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Credential | MD
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Telephone | 888-789-9585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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