MEDICARE: DR. CHESTER M TYLKOWSKI 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
1	284300000X	Special Hospital	30955	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30955	OTHER	KY	STATE LICENSE

General Provider Information

NPI Number	:	1396954558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHESTER M TYLKOWSKI M.D.

Provider Business Mailing Address
First Line	:	1900 RICHMOND RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-1204
Country	:	US
Telephone Number	:	859-268-5622
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 RICHMOND RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-1204
Country	:	US
Telephone Number	:	859-268-5622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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