Provider Demographics
NPI:1497761894
Name:KENTUCKY FERTILITY AND ANDROLOGY, PLLC
Entity Type:Organization
Organization Name:KENTUCKY FERTILITY AND ANDROLOGY, PLLC
Other - Org Name:
Other - Org Type:
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:PO BOX 24787
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40524-4787
Mailing Address - Country:US
Mailing Address - Phone:859-277-5736
Mailing Address - Fax:859-276-2236
Practice Address - Street 1:141 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 203
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1832
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:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02485207VE0102X
KYPA779363A00000X
KY2995P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Not Answered363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty