Organization
CENTRAL KENTUCKY RADIOLOGY
Active
Other names
Danville Diagnostic Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON K KOSTELIC MD (PRESIDENT)
(859) 219-0542
Entity
Organization
Contact information
Practice address
124 DANIEL DR, DANVILLE, KY 40422-2527
(859) 936-9974
(859) 936-0973
Mailing address
1218 S BROADWAY, STE 310, LEXINGTON, KY 40504-2759
(859) 219-0542
(859) 219-9433
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000061387
ANTHEM
KY
05
—
65931644
—
KY
Enumeration date
04/13/2009
Last updated
04/13/2009
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