Provider Demographics
NPI:1386635670
Name:EKLUND, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:EKLUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 N DIXIE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701
Mailing Address - Country:US
Mailing Address - Phone:270-769-1049
Mailing Address - Fax:270-735-1978
Practice Address - Street 1:914 NORTH DIXIE
Practice Address - Street 2:SUITE 304
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701
Practice Address - Country:US
Practice Address - Phone:270-769-1049
Practice Address - Fax:270-735-1978
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY33499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64343999Medicaid
KY64343999Medicaid
G21591Medicare UPIN