Provider Demographics
NPI:1518079649
Name:PAYNE, KENNETH J (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:PAYNE
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 1:1104 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2256
Mailing Address - Country:US
Mailing Address - Phone:502-797-9940
Mailing Address - Fax:
Practice Address - Street 1:601 S FLOYD ST STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1837
Practice Address - Country:US
Practice Address - Phone:502-629-1515
Practice Address - Fax:502-629-1545
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40305207V00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000641999OtherANTHEM- LUIS M. VELASCO, MD & ASSOCIATES
KY000052152UOtherHUMANA- LUIS VELASCO, MD & ASSOCIATES
KY3760421000OtherPASSPORT ADVANTAGE- LUIS M. VELASCO, MD & ASSOC
KY64121569Medicaid
KY110222OtherSIHO- LUIS M. VELASCO, MD & ASSOC.
KY3738590OtherCIGNA- LUIS M. VELASCO, MD & ASSOC.
KYP00861080OtherRAILROAD MEDICARE- LUIS M. VELASCO, MD & ASSOC.
IN200979140Medicaid
OH2691832Medicaid
KY50027081OtherPASSPORT- LUIS M. VELASCO, MD & ASSOC.
IN200979140Medicaid
KY64121569Medicaid
KY110222OtherSIHO- LUIS M. VELASCO, MD & ASSOC.