Provider Demographics
NPI:1003925074
Name:KHALILY, CYNA (MD)
Entity Type:Individual
Prefix:
First Name:CYNA
Middle Name:
Last Name:KHALILY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:SUITE 604
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-629-5633
Practice Address - Fax:502-629-5580
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY31555207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY108676OtherSIHO - NOTC (B&J)
KY3745094000OtherPASSPORT ADVANTAGE - NOTC (B&J)
P00290683OtherRR MEDICARE
KY50001643OtherPASSPORT
KY64315559Medicaid
KYP00833212OtherRR MEDICARE NOTC (B&J)
KY2443211000OtherPASSPORT ADVANTAGE
KY3241175OtherCIGNA - NOTC (B&J)
KY000052152MOtherHUMANA - NOTC (B&J)
IN200181350Medicaid
KY50026229OtherPASSPORT - NOTC (B&J)
KY000000634077OtherANTHEM - NOTC (B&J)
KY000000634077OtherANTHEM - NOTC (B&J)
KY3745094000OtherPASSPORT ADVANTAGE - NOTC (B&J)
KY108676OtherSIHO - NOTC (B&J)
F87174Medicare UPIN