Provider Demographics
NPI:1164685434
Name:DR PETER KO PLLC
Entity Type:Organization
Organization Name:DR PETER KO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-263-4817
Mailing Address - Street 1:3260 BLAZER PARKWAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2116
Mailing Address - Country:US
Mailing Address - Phone:859-263-4817
Mailing Address - Fax:
Practice Address - Street 1:3260 BLAZER PARKWAY
Practice Address - Street 2:SUITE 102
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2116
Practice Address - Country:US
Practice Address - Phone:859-263-4817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7293OtherMEDICARE GROUP ID
7293OtherMEDICARE GROUP ID
0729301Medicare PIN