MEDICARE: DR PETER KO PLLC

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
1	207Q00000X	Family Medicine Physician	34165	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7293	OTHER		MEDICARE GROUP ID

General Provider Information

NPI Number	:	1164685434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR PETER KO PLLC

Provider Business Mailing Address
First Line	:	3260 BLAZER PARKWAY
Second Line	:	SUITE 102
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2116
Country	:	US
Telephone Number	:	859-263-4817
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 BLAZER PARKWAY
Second Line	:	SUITE 102
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2116
Country	:	US
Telephone Number	:	859-263-4817
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PETER H KO
Credential	:	MD
Telephone Number	:	859-263-4817

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/17/2008

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