Provider Demographics
NPI:1629014675
Name:AVANESOV, KAREN (DO)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:AVANESOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E GRAY ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3900
Mailing Address - Country:US
Mailing Address - Phone:502-584-7525
Mailing Address - Fax:502-584-6851
Practice Address - Street 1:210 E GRAY ST
Practice Address - Street 2:SUITE 900
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3900
Practice Address - Country:US
Practice Address - Phone:502-584-7525
Practice Address - Fax:502-584-6851
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238138204D00000X, 207XS0117X, 207X00000X
KY03167207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3740627000OtherPASSPORT ADVANTAGE- NORTON LEATHERMAN SPINE CENTER
KY7100084130Medicaid
KY50025970OtherPASSPORT- NORTON LEATHERMAN SPINE CENTER
KY200952070OtherSIHO- NORTON LEATHERMAN SPINE CENTER
KY000000628579OtherANTHEM- NORTON LEATHERMAN SPINE CENTER
KY000051983POtherHUMANA- NORTON LEATHERMAN SPINE CENTER
KY00533170OtherADVANTRA FREEDOM- NORTON LEATHERMAN SPINE CENTER
KY200952070OtherHEALTHY INDIANA PLAN- NORTON LEATHERMAN SPINE CENTER
IN200952070Medicaid
KY200952070OtherHEALTHY INDIANA PLAN- NORTON LEATHERMAN SPINE CENTER