Provider Demographics
NPI:1114015583
Name:DESOYZA, NEIL D B (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:D B
Last Name:DESOYZA
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 1:380 CENTRE VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3476
Mailing Address - Country:US
Mailing Address - Phone:859-341-3015
Mailing Address - Fax:859-341-3215
Practice Address - Street 1:380 CENTRE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3476
Practice Address - Country:US
Practice Address - Phone:859-341-3015
Practice Address - Fax:859-341-3215
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY21895207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64218951Medicaid
KYP00920129OtherRR MEDICARE
OH2268791Medicaid
KYP00920129OtherRR MEDICARE
KYP400040821Medicare PIN