Provider Demographics
NPI:1275547606
Name:KENTUCKY FERTILITY AND GYNECOLOGY, PLLC.
Entity Type:Organization
Organization Name:KENTUCKY FERTILITY AND GYNECOLOGY, PLLC.
Other - Org Name:KENTUCKY PRIMARY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VELOUDIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:859-277-5736
Mailing Address - Street 1:170 N EAGLE CREEK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-9087
Mailing Address - Country:US
Mailing Address - Phone:859-277-5736
Mailing Address - Fax:859-276-2236
Practice Address - Street 1:170 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-9087
Practice Address - Country:US
Practice Address - Phone:859-277-5736
Practice Address - Fax:859-276-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02485207V00000X, 207V00000X
KYPA779363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65932980Medicaid
KY7100107450Medicaid
KY1275547606OtherNPI
KY1275547606OtherNPI