Individual
KONSTANTINOS G SKANDAMIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1930 BISHOP LN, STE 1600, LOUISVILLE, KY 40218-1921
(502) 272-5100
(502) 272-5116
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
Primary
38006
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000382368
ANTHEM
KY
01
—
047513
SIHO
KY
01
—
13219442
CHA- NORTON ICC
KY
01
—
200505860
ANTHEM INDIANA MEDICAID- NORTON ICC
IN
01
—
200505860
HEALTHY INDIANA PLAN- NORTON ICC
KY
05
—
200505860
—
IN
01
—
P00293208
RAILROAD MEDICARE
KY
01
—
P00305292
RAILROAD MEDICARE
KY
Enumeration date
04/20/2006
Last updated
09/02/2016
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