1679681076 NPI number — JOEL G KREILEIN MD

Table of content: JOEL G KREILEIN MD (NPI 1679681076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679681076 NPI number — JOEL G KREILEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREILEIN
Provider First Name:
JOEL
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679681076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 ALEXANDRIA PIKE
Provider Second Line Business Mailing Address:
STE 220
Provider Business Mailing Address City Name:
SOUTHGATE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-441-7774
Provider Business Mailing Address Fax Number:
859-441-7972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 ALEXANDRIA PIKE
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
SOUTHGATE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-441-7774
Provider Business Practice Location Address Fax Number:
859-441-7972
Provider Enumeration Date:
08/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208200000X , with the licence number:  19552 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2082S0105X , with the licence number: 19552 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64195522 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000033112 . This is a "ANTHEM BLUE CROSS & SHIEL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1320080 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com