Provider Demographics
NPI:1497872899
Name:DOS REMEDIOS, ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:DOS REMEDIOS
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 1:1111 MEDICAL CENTER CIR
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1194
Mailing Address - Country:US
Mailing Address - Phone:270-251-4040
Mailing Address - Fax:855-430-0335
Practice Address - Street 1:1111 MEDICAL CENTER CIR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1194
Practice Address - Country:US
Practice Address - Phone:270-251-4040
Practice Address - Fax:855-430-0335
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40940207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY40940OtherSTATE LIC
NY239218OtherNY LICENSE NO
KY7100021670Medicaid
KYTP203OtherTEMP LIC
KYTP203OtherTEMP LIC
KYNO LONGER ISSUEDMedicare UPIN
KY7100021670Medicaid