Provider Demographics
NPI:1467437335
Name:KOBY, MELVYN M (MD)
Entity Type:Individual
Prefix:
First Name:MELVYN
Middle Name:M
Last Name:KOBY
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 206068
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40250-6068
Mailing Address - Country:US
Mailing Address - Phone:502-896-2064
Mailing Address - Fax:502-897-0489
Practice Address - Street 1:4004 DUPONT CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4819
Practice Address - Country:US
Practice Address - Phone:502-897-1604
Practice Address - Fax:502-897-0489
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14046207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64140460Medicaid
KY180007621OtherMEDICARE RR
CB0333OtherGROUP RAILROAD MEDICARE
000000485424OtherBLUE SHIELD
0035102Medicare PIN
C64712Medicare UPIN
0268650001Medicare NSC