Provider Demographics
NPI:1770506073
Name:CILIBERTI, SALVATORE A (MD)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:A
Last Name:CILIBERTI
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 1:9517 US HIGHWAY 42 STE 410
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9237
Mailing Address - Country:US
Mailing Address - Phone:502-587-0521
Mailing Address - Fax:502-587-3888
Practice Address - Street 1:9517 US HIGHWAY 42 STE 410
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9237
Practice Address - Country:US
Practice Address - Phone:502-587-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY22155207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64221559Medicaid
KY1770506073OtherNPI
KY1770506073OtherNPI
KY0782Medicare PIN
KY110044140Medicare PIN
KY0958Medicare PIN
KY64221559Medicaid