Provider Demographics
NPI:1457333502
Name:GALLUS, COREY (DO)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:GALLUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CHAMBER CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1673
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-301-7216
Practice Address - Street 1:1808 BRISTOW DRIVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-3513
Practice Address - Country:US
Practice Address - Phone:859-301-7210
Practice Address - Fax:859-301-7216
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64012750Medicaid
OH2387608Medicaid
KY0364928Medicare PIN
KY080162016Medicare PIN
OH2387608Medicaid