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NPI Code Detail

MEDICARE: DR. KENNETH GREGORY PUGH M.D.

MEDICARE: DR. KENNETH GREGORY PUGH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0300XGeriatric Medicine (Internal Medicine) Physician01088782AIN
2207RG0300XGeriatric Medicine (Internal Medicine) Physician0101050097VA
3207RG0300XGeriatric Medicine (Internal Medicine) PhysicianME138875FL
4207RG0300XGeriatric Medicine (Internal Medicine) Physician57574KY

General Provider Information

NPI Number : 1164583043
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH GREGORY PUGH M.D.
Provider Business Mailing Address
First Line : 4915 NORTON HEALTHCARE BLVD STE 301
Second Line : SUITE 301
City : LOUISVILLE
State : KY
Zip : 40241-2866
Country : US
Telephone Number : 502-394-6460
Fax Number : 502-394-6465
Provider Business Practice Location Address
First Line : 4915 NORTON HEALTHCARE BLVD STE 301
Second Line :
City : LOUISVILLE
State : KY
Zip : 40241-2866
Country : US
Telephone Number : 301-661-5076
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 03/28/2026

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