Provider Demographics
NPI:1073619128
Name:BLUEGRASS NEWBORN SPECIALISTS, PLC
Entity Type:Organization
Organization Name:BLUEGRASS NEWBORN SPECIALISTS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHALDON
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-221-6339
Mailing Address - Street 1:1408 BRIANNA COURT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1822
Mailing Address - Country:US
Mailing Address - Phone:859-272-1146
Mailing Address - Fax:859-272-1146
Practice Address - Street 1:170 NORTH EAGLE CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1805
Practice Address - Country:US
Practice Address - Phone:859-967-5416
Practice Address - Fax:859-967-5415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY291682080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65946030Medicaid
KY65946030Medicaid