Organization
KENTUCKY MEDICAL SPECIALISTS, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLON R CHAGUA MD (PRESIDENT)
(502) 893-7372
Entity
Organization
Contact information
Practice address
4001 KRESGE WAY STE # 236, LOUISVILLE, KY 40207
(502) 893-7372
(502) 409-4715
Mailing address
4001 KRESGE WAY STE # 236, LOUISVILLE, KY 40207
(502) 893-7372
(502) 409-4715
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
36325
KY
207R00000X
Internal Medicine Physician
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64063266
—
KY
05
—
7100235310
—
KY
Enumeration date
07/10/2012
Last updated
05/01/2019
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