Provider Demographics
NPI:1124010814
Name:KFOURY, WAJDI S (MD)
Entity Type:Individual
Prefix:DR
First Name:WAJDI
Middle Name:S
Last Name:KFOURY
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:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-0182
Mailing Address - Country:US
Mailing Address - Phone:606-767-1577
Mailing Address - Fax:606-523-8581
Practice Address - Street 1:1 TRILLIUM WAY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8727
Practice Address - Country:US
Practice Address - Phone:606-526-4449
Practice Address - Fax:606-523-8581
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38881207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000358174OtherBCBS- EBMC LOC.
KY000000521524OtherBCBS-KFOURY MED SPEC. LOC
KY64089154Medicaid
KY00288001Medicare PIN
KY64089154Medicaid
KY000000358174OtherBCBS- EBMC LOC.
KY0374011Medicare PIN