# STRIVEMD WELLNESS & KETAMINE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558957415
- **Authorized official:** DR. DANNY PARK MD (MD)
- **Authorized official phone:** (419) 509-3726

## Contact information

- **Practice address:** 527 CENTRE VIEW BLVD, CRESTVIEW HILLS, KY 41017-3444
- **Practice address phone:** (859) 415-0056
- **Mailing address:** 527 CENTRE VIEW BLVD, CRESTVIEW HILLS, KY 41017-3444
- **Mailing address phone:** (859) 415-0056

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/15/2020
- **Last updated:** 12/15/2020