Individual
ANN ELIZABETH ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1230 MARKET ST, LA GRANGE, KY 40031-7986
(502) 225-6900
(502) 666-7693
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
KY26442
KY
208D00000X
General Practice Physician
26442
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000617689
ANTHEM
KY
01
—
3722091000
PASSPORT ADVANTAGE
KY
01
—
50024361
PASSPORT
KY
05
—
64264427
—
KY
01
—
P00746838
RAILROAD MEDICARE
KY
Enumeration date
09/23/2005
Last updated
12/05/2018
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