Provider Demographics
NPI:1518079649
Name:PAYNE, KENNETH J (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:PAYNE
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 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-272-5100
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:601 S FLOYD ST STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1837
Practice Address - Country:US
Practice Address - Phone:502-629-1515
Practice Address - Fax:502-629-1545
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40305207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3738590OtherCIGNA- LUIS M. VELASCO, MD & ASSOC.
KY000000641999OtherANTHEM- LUIS M. VELASCO, MD & ASSOCIATES
KY50027081OtherPASSPORT- LUIS M. VELASCO, MD & ASSOC.
KY64121569Medicaid
KY110222OtherSIHO- LUIS M. VELASCO, MD & ASSOC.
OH2691832Medicaid
KYP00861080OtherRAILROAD MEDICARE- LUIS M. VELASCO, MD & ASSOC.
KY000052152UOtherHUMANA- LUIS VELASCO, MD & ASSOCIATES
IN200979140Medicaid
KY3760421000OtherPASSPORT ADVANTAGE- LUIS M. VELASCO, MD & ASSOC
IN200979140Medicaid
KY64121569Medicaid
KY110222OtherSIHO- LUIS M. VELASCO, MD & ASSOC.