Provider Demographics
NPI:1518222959
Name:TOBOREK, AGATA M (MD)
Entity Type:Individual
Prefix:DR
First Name:AGATA
Middle Name:M
Last Name:TOBOREK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N EAGLE CREEK DR
Mailing Address - Street 2:STE 250
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1827
Mailing Address - Country:US
Mailing Address - Phone:859-258-5141
Mailing Address - Fax:859-258-5168
Practice Address - Street 1:120 N EAGLE CREEK DR
Practice Address - Street 2:STE 250
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1827
Practice Address - Country:US
Practice Address - Phone:859-258-5141
Practice Address - Fax:859-258-5168
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012016747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0169Medicare PIN