Provider Demographics
NPI:1700854064
Name:FELIPE-MORALES, JAVIER A (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:A
Last Name:FELIPE-MORALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2300 CHAMBER CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1673
Mailing Address - Country:US
Mailing Address - Phone:859-344-3945
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:1400 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2570
Practice Address - Country:US
Practice Address - Phone:859-757-2141
Practice Address - Fax:859-441-2111
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35047123208800000X
KY47394208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH340019972OtherMEDICARE RAILROAD
KY7100305400Medicaid
OH0502370Medicaid
OH340019972OtherMEDICARE RAILROAD
OHB77543Medicare UPIN
OH0515932Medicare PIN