Provider Demographics
NPI:1194874586
Name:CILIBERTI, PAUL JOHN (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOHN
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 1:306C MIDDLETOWN PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243
Mailing Address - Country:US
Mailing Address - Phone:502-245-2661
Mailing Address - Fax:502-245-2668
Practice Address - Street 1:306C MIDDLETOWN PARK PLACE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243
Practice Address - Country:US
Practice Address - Phone:502-245-2661
Practice Address - Fax:502-245-2668
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19741207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B16306Medicare UPIN
KY1643501Medicare ID - Type Unspecified