Individual
EUGENE GILES SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1720 W BROADWAY STE 107, LOUISVILLE, KY 40203-3607
(502) 340-5900
(502) 772-1761
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 272-5063
(502) 772-1761
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
22657
KY
207R00000X
Internal Medicine Physician
Primary
22657
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000062872
ANTHEM
—
01
—
0400136
UNITED HEALTHCARE
—
01
—
1049423
PASSPORT
—
05
—
64226574
—
KY
Enumeration date
09/07/2005
Last updated
08/28/2024
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