Individual
KRISTOPHER ZEPHINAR FANNIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3101 POPLAR LEVEL RD STE 101, LOUISVILLE, KY 40213-1076
(502) 636-7444
(502) 636-7112
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
45200
KY
207Q00000X
Family Medicine Physician
R2574
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201107020
—
IN
05
—
7100138510
—
KY
Enumeration date
03/30/2009
Last updated
03/22/2024
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