Provider Demographics
NPI:1679681076
Name:KREILEIN, JOEL G (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:G
Last Name:KREILEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:525 ALEXANDRIA PIKE
Mailing Address - Street 2:STE 220
Mailing Address - City:SOUTHGATE
Mailing Address - State:KY
Mailing Address - Zip Code:41071
Mailing Address - Country:US
Mailing Address - Phone:859-441-7774
Mailing Address - Fax:859-441-7972
Practice Address - Street 1:525 ALEXANDRIA PIKE
Practice Address - Street 2:STE 220
Practice Address - City:SOUTHGATE
Practice Address - State:KY
Practice Address - Zip Code:41071
Practice Address - Country:US
Practice Address - Phone:859-441-7774
Practice Address - Fax:859-441-7972
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY19552208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Not Answered2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64195522Medicaid
000000033112OtherANTHEM BLUE CROSS & SHIEL
1320080OtherUNITED HEALTHCARE
C02039Medicare UPIN
1320080OtherUNITED HEALTHCARE