Organization
KFOURY MEDICAL SPECIALISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAJDI S KFOURY MD (OWNER AND MEMBER)
(606) 309-1806
Entity
Organization
Contact information
Practice address
1 TRILLIUM WAY, CORBIN, KY 40701-8727
(606) 309-1806
(606) 657-5734
Mailing address
PO BOX 2828, LONDON, KY 40743-2828
(606) 309-1806
(606) 657-5734
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
38881
KY
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000521523
BCBS OF KY
KY
05
—
7100010200
—
KY
Enumeration date
03/27/2007
Last updated
10/12/2015
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