Individual
TIMOTHY JAMES AVERION-MAHLOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-4181
(859) 258-4058
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-4181
(859) 258-4058
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
39177
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
64097926
—
KY
01
—
CB5773
RR MEDICARE GRP
KY
01
—
P00194694
MEDICARE RR PIN
KY
Enumeration date
06/24/2006
Last updated
11/02/2007
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