Provider Demographics
NPI:1093764847
Name:BRODSKY, KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BRODSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LINVILLE DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-2165
Mailing Address - Country:US
Mailing Address - Phone:859-987-8432
Mailing Address - Fax:859-987-8433
Practice Address - Street 1:5 LINVILLE DR
Practice Address - Street 2:SUITE 104
Practice Address - City:PARIS
Practice Address - State:KY
Practice Address - Zip Code:40361-2165
Practice Address - Country:US
Practice Address - Phone:859-987-8432
Practice Address - Fax:859-987-8433
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH04994Medicare UPIN
KY9907Medicare PIN