Provider Demographics
NPI:1063411650
Name:STRUNK, ROGER W (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:W
Last Name:STRUNK
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:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4607
Practice Address - Street 1:593 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-2332
Practice Address - Country:US
Practice Address - Phone:502-223-0308
Practice Address - Fax:502-227-5764
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65934895Medicaid
KY10015515OtherRAILROAD MEDICARE
KY000000048740OtherANTHEM BCBS
KY64235138Medicaid
KYC30629OtherRAILROAD MEDICARE
KYC30629OtherRAILROAD MEDICARE
KYC69324Medicare UPIN
KY65934895Medicaid