Individual
MR. GEORGE AVERY KONDIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2845 CHANCELLOR DR, CRESTVIEW HILLS, KY 41017-3418
(859) 426-4200
(859) 426-4206
Mailing address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 301-2663
(859) 301-0655
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA568
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000241201
ANTHEM
KY
01
—
428850003
MEDICARE DME
KY
01
—
90008962
MEDICAID DME
KY
05
—
95001970
—
KY
01
—
970027844
RAILROAD MEDICARE
KY
01
—
CB8861
RAILROAD MEDICARE
KY
Enumeration date
06/17/2005
Last updated
05/12/2015
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