Individual
DWAYNE LIKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
200 E CHESTNUT ST BLDG SUITE303, LOUISVILLE, KY 40202
(502) 629-5552
(502) 629-3132
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0102204025
VA
207Q00000X
Family Medicine Physician
Primary
04064
KY
207Q00000X
Family Medicine Physician
2827
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300032286
—
IN
05
—
7100418380
—
KY
01
—
K239373
MEDICARE
KY
Enumeration date
07/19/2011
Last updated
02/09/2023
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